Referral Pattern Changes Over a Decade in a Tertiary Neuro-Ophthalmology Clinic

To evaluate changes in referral patterns, including referral sources, patient demographics, and diagnostic patterns to a neuro-ophthalmology unit in a single tertiary medical center across two distinct three-year periods, a decade apart.

A retrospective database analysis of patients seen for their initial visit in the NO Unit at a tertiary Medical Center in Israel during January 1^st, 2007-December 31^st, 2009 (Group 1-1436 patients), and during January 1^st 2017-December 31^st 2019 (Group 2-2104 patients). Data collected included patients' age, gender, referring provider specialty, primary complaint, clinical findings, and final diagnosis.

Patients in Group 2 were significantly older than those in Group 1 (p < 0.024). There was a significant increase in referrals from ophthalmologists (p < 0.001) and pediatricians (p < 0.001), while referrals from neurologists (p < 0.006) and rehabilitation specialists (p < 0.003) declined, Diagnoses related to vision changes increased significantly over time (p <0.001). Diagnoses related to complaint of diplopia were more frequent in Group 2 (p < 0.01). A multinomial logistic regression further demonstrated that, after adjusting for age and sex, diagnoses of pseudotumor cerebri (PTC) (OR = 1.46, p = 0.004) and tumor/compressive lesions (OR = 1.55, p < 0.001) were significantly more likely in Group 2 compared with Group 1, whereas optic nerve disease, ocular motility disorders, and visual function complaints showed no significant temporal change.

The study demonstrated an increase in referrals to NO services and a demographic shift toward older patient population. These findings emphasize the growing need for neuro-ophthalmologic expertise, particularly in the context of an aging population. Multinomial regression further showed that diagnoses of PTC and tumor/compressive lesions became significantly more common over the decade, highlighting evolving diagnostic trends that may inform resource allocation and future service planning.