Exploring the effect of optometrist practice type on NHS funded sight test outcome

The United Kingdom (UK) National Health Service (NHS) currently provides sight tests at no cost to patients for all those aged <16 or ≥60. Some 'at-risk' patients and those in receipt of means-tested benefits are eligible for a NHS sight test between the ages of 16 and 60. In the UK, community optometrists typically either work in independent or national chain practices (multiples). The present study aims to explore whether practice type has any association with sight test outcome. As sight tests are essential in detecting early childhood visual problems, we also aim to explore children's first sight tests.

Data from 664,480 NHS sight test claims submitted in Essex from April 2015 to September 2016 were analysed using regression analysis. Practice type (multiple, independent) and children's first sight test were examined with respect to socio-economic status (SES, based on index of multiple deprivation rankings), age and sight test outcome.

The median age for a first NHS sight test was 6 years old and was clinically independent of SES. Children's first sight tests typically resulted in neither a spectacle prescription being issued nor an onwards referral. Patients that attend multiples are significantly more likely to receive a new prescription, relative to no prescription, compared to a patient attending an independent (p<.001).

Inequalities in sight test outcome appear to exist with differing type of practice (independent or multiple). Choice of practice type appears to be influenced by SES. Children have their first sight test at a later age than recommended.