Mohamed Morgan
Clinical audits are a core requirement for the Foundation Programme and provide an excellent way for Ophthalmology applicants to gain up to 5 points on the portfolio. It is often difficult decide on a valid topic for an audit. Furthermore, most foundation doctors will not have a rotation in Ophthalmology. This article will discuss 5 potential audit topics relating to ophthalmology for Foundation doctors to undertake both with a rotation in ophthalmology and without.
1) Visual assessments in patients presenting with falls
Relevant rotation: Geriatric Medicine
Aim: To determine whether visual assessments are being performed in patients presenting with falls on acute Geriatrics Medicine wards.
Standard: Vision status should be assessed as part of the comprehensive geriatric assessment.
Data points:
- Vision documented in medical notes
- Patient past ocular history
- Patient current visual acuity
- Visual impairment accounted for in management plan
Why this audit is valuable: Visual impairment is a well-documented but often overlooked risk factor for falls. Addressing vision can the reduce risk of falls recurrence and fracture rates (1).
2) Monitoring for hydroxychloroquine Retinopathy
Relevant rotations: GP, Rheumatology
Aim: Are patients prescribed long-term hydroxychloroquine appropriately referred for retinal screening?
Standard: Baseline monitoring should be performed at 1 year (if risk-factors present) or 5 years and continued annually – Royal College of Ophthalmology guidelines (2).
Data points:
- Duration and dose of hydroxychloroquine
- Evidence of ophthalmology referral
- Documentation of patient counselling
Why this audit is valuable: Hydroxychloroquine is a medication used to treat several rheumatological conditions including rheumatoid arthritis and systemic lupus erythematosus. One known adverse effect associated with long-term use of this medication is irreversible retinal toxicity. Identifying missed cases can help prevent potentially irreversible eye disease.
3) Reviewing microbiological profiles in orbital cellulitis cultures
Relevant rotation: Ophthalmology
Aim: To review microbiological profiles of orbital cellulitis cultures regionally which can help direct empiric antibiotic use
Standard: Empirical antibiotics should provide adequate coverage for the most commonly isolated organisms in orbital cellulitis.
Data points:
- Patient age
- Source of culture (eye, sinus)
- Culture type (swab, pus)
- Culture growths and sensitivities
- Empirical antibiotics started
Why this audit is valuable: Orbital cellulitis is a potentially site-threatening condition that requires urgent IV antibiotic treatment. Empirical antibiotics must cover the most common bacteria, accounting for geographical variations in causative micro-organisms (3).
4) Eye tape anaesthetics
Relevant rotation: Anaesthetics
Aim: To assess whether adequate eye protection is being used in patients undergoing general anaesthesia, and its effectiveness.
Standard: The Royal College of Anaesthetists recommends eyes should be taped shut when patients are put under general anaesthesia (4).
Data points:
- Documentation of eye protection
- Post-operative eye complications
- Type and duration of surgery
Why this audit is valuable: Damage to the eye, such as corneal abrasions, are a recognised complication of general anaesthesia. The royal college of anaesthetics advise these eye injuries can be prevented with careful protection of the eyes (4).
5) Timeliness of Retinopathy of Prematurity screening
Relevant rotations: Paediatrics, Ophthalmology
Aim: To assess whether eligible preterm infants are screened for Retinopathy of Prematurity (ROP) within the recommended timeframe.
Standard: All premature infants born <32 weeks’ gestation or weighing <1501g should be initially screened for the ROP between 31+0 and 31+6 weeks’ postmenstrual age, or at 4 completed weeks’ postnatal age, whichever is later (5).
Data points:
- Gestational age and birth weight
- Eligibility for Retinopathy of Prematurity screening
- Timing of first screen
- Documentation of follow-up plans
Why this audit is valuable: Premature babies are at risk of sight-threatening, retinopathy of prematurity (ROP). It is important to initiate this screening soon enough to detect the earliest possible onset of potentially severe disease due to the risk of irreversible damage.
References
- Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol. 2005 Jan;89(1):53-9. doi: 10.1136/bjo.2004.049478. PMID: 15615747; PMCID: PMC1772474.
- Yusuf IH, Foot B, Galloway J, Ardern-Jones MR, Watson SL, Yelf C, et al. The Royal College of Ophthalmologists recommendations on screening for hydroxychloroquine and chloroquine users in the United Kingdom: executive summary. Eye (London, England). 2018;32(7):1168-73.
- Ambati BK et al. (2000): Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination. Ophthalmology 107: 1450-1453
- Royal College of Anaesthetists, Section 5: Damage to the eye during general anaesthesia, Risks associated with your anaesthesia. Available from: https://www.rcoa.ac.uk/patients/patient-information-resources/anaesthesia-risk/risks-associated-general-anaesthesia.
- Royal College of Paediatrics and Child Health, UK Screening of Retinopathy of Prematurity Guideline, 2024. Available at: https://www.rcpch.ac.uk/resources/screening-retinopathy-prematurity-rop-clinical-guideline.