Who Gets Referred for What? Large Scale Analysis of Clinical, Socioeconomic and Demographic Drivers Within Electronic Optometry Referrals

Abstract Objective To provide the first large-scale analysis of Electronic Eyecare Referral System (EeRS) data, examining referral patterns, demographic differences and geographical variation by socioeconomic deprivation overall. Methods A retrospective analysis was conducted of 104,190 referrals submitted via the National Health Service (NHS) England North West’s EeRS between June 2022 and May 2024. Descriptive analyses summarised referral destinations and putative optometric diagnoses. Chi-squared tests with Bonferroni correction examined sex differences across referral endpoints. Multivariable logistic regression assessed associations between deprivation (Index of Multiple Deprivation (IMD) decile) and condition-specific referral odds, adjusting for age, sex and ethnicity. Results Most referrals were directed to ophthalmology in secondary care (71.6%). The most common referral endpoints were glaucoma (12.2%), other medical retina (11.6%) and YAG laser capsulotomy (11.1%). Referrals within primary care accounted for 18.2%, predominantly referrals to general practice (15.0%), while referrals to glaucoma referral filtering comprised 3.0% of all referrals. Significant sex differences in referral distribution across several subspecialty endpoints were observed ( p < 0.003). Deprivation-related and geographical variation was evident, with higher odds of cataract (Odds Ratio (OR) per IMD decile 0.97, 95% CI 0.97–0.98) and paediatric binocular vision referrals (OR 0.96, 95% CI 0.94–0.98) in more deprived areas, whereas vitreoretinal, adult binocular vision and other medical retina referrals were more common in less deprived areas. Conclusions Electronic optometry referrals showed substantial variation by condition and area-level socioeconomic context. Linking referral data to deprivation measures may help identify variation in referral activity and support strategies to improve eye examination uptake and optimise referral pathways.