School of Medicine, Deakin University, Geelong, Victoria, Australia.
Centre of Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia.
Ophthalmic Physiol Opt. 2022 Jan;42(1):149-160. doi: 10.1111/opo.12902. Epub 2021 Oct 12.
To develop expert consensus on referral criteria for low vision services in Australia.
In a modified online Delphi process, a panel of 38 Australian experts in low vision (including ophthalmologists, optometrists, orthoptists, occupational therapists, orientation and mobility professionals, researchers and managers) participated in three rounds of consensus building over a period of 5 months commencing in 2019. Initially, 90 statements were developed, addressing what should be included in best-practice low vision referral criteria, currently used criteria, timing of referral and responsibility for referral. By the third round, these had been reduced and refined to a total of four statements.
In three Delphi rounds, the expert panel produced three key recommendations for low vision referral: (1) that low vision referral should be based mainly on the impact of uncorrectable vision impairment on function and well-being; (2) clinical measures of visual acuity and visual field might be a secondary consideration and (3) it is important to fully inform a person about low vision services at an early stage of vision loss and to involve them in decision making about referral. There was consensus on the need for clear referral pathways and that both ophthalmologists and optometrists have primary responsibility to refer for low vision services.
Although recommendations and guidelines should not replace sound individual clinical judgement, promotion and adoption of these consensus recommendations could assist health care professionals in providing appropriate and timely referral for low vision services to the benefit of people with vision impairment.
制定澳大利亚低视力服务转诊标准的专家共识。
在一项改良的在线德尔菲法研究中，一个由 38 名澳大利亚低视力专家组成的小组（包括眼科医生、验光师、视轴矫正师、职业治疗师、定向和移动专家、研究人员和管理人员）参与了三个回合的共识建立，为期 5 个月，始于 2019 年。最初，制定了 90 项陈述，涉及最佳实践低视力转诊标准应包括的内容、目前使用的标准、转诊时间和转诊责任。到第三轮，这些陈述已被缩减和细化为总共四项陈述。
在三轮德尔菲法研究中，专家小组提出了三项低视力转诊的关键建议：（1）低视力转诊应主要基于不可矫正视力损害对功能和福祉的影响；（2）视力和视野的临床测量可能是次要考虑因素；（3）在视力丧失的早期阶段，充分告知患者有关低视力服务的信息并让他们参与转诊决策非常重要。专家小组一致认为需要明确的转诊途径，眼科医生和验光师都有主要责任转介低视力服务。
尽管建议和指南不应替代合理的个体临床判断，但推广和采用这些共识建议可以帮助医疗保健专业人员为低视力服务提供适当和及时的转诊，使视力受损的人受益。
