A Delphi Consensus Study To Determine The Feasibility of Implementing Guidelines for Refractive Management of Older Patients at Risk of Falls

Kam Chun Ho, David Elliott, Emily Charlesworth, Rajendra Gyawali, Lisa Keay

Research output: Contribution to conference (non-published works)Posterpeer-review


Purpose : Spectacle prescribing has been shown to impact the risk of falls in older adults and changes are often required after cataract surgery. In 2019, Optometry Australia Guidelines for optometrists summarised the literature and made recommendations to optometrists on how to manage older patients to minimise the risk of falls. This study aimed to use the Delphi technique to gain perspectives on the importance and feasibility of implementing the recommendations.

Methods : A two-round Delphi technique was used to refine a list of 28 evidence-based recommendations with a panel of 11 Australian optometrists currently involved in refractive management of patients with cataract. In the first round, they were asked to comment and rate each recommendation for feasibility and importance on a 5-point agreement scale and whether they already follow this recommendation in their practices. In the second round, they were given a summary of round 1 results and asked to re-rate the feasibility and importance for recommendations without consensus from first round (
Results : Twenty recommendations (71%) reached consensus (≥80% agreement) in the first round. Recommendation with high consensus but low uptake were history taking about risk of falls (36%) and advising to patients to seek home modification via occupational therapists and other professionals (55%). Australian optometrists would instead refer these patients to low vision services. Other barriers included high cost for multiple pairs of spectacles, the need to delegate some tasks to other practice staff and availability of equipment such as progressive additional lenses for demonstration. There was resistance when recommendations were too prescriptive and could not fit all cases.

Conclusions : Overall, practicing optometrists showed a high level of support for the recommendations and made practical recommendations for implementation. There was some areas of low awareness and scope for improvements to practice in order to meet evidence-based recommendations for prescribing spectacles to minimise falls risk. Full adoption of the evidence-based guidelines could be facilitated with the involvement of practice staffs and practical considerations like costs, individual visual needs and circumstances.
Original languageEnglish
Number of pages1
Publication statusPublished - 3 May 2020
Externally publishedYes
EventARVO Annual Meeting 2020 -
Duration: 3 May 20207 May 2020


ConferenceARVO Annual Meeting 2020


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