International Ophthalmology

, Volume 38, Issue 5, pp 1923–1931 | Cite as

An evidence-based medicine audit of the ophthalmic emergency services unit of King Abdulaziz University Hospital (KAUH)

  • Adel Alsuhaibani
  • Mohammed AlRajeh
  • Priscilla Gikandi
  • Ahmed MousaEmail author
Original Paper



To improve the interventions provided for patients presenting with acute ophthalmic conditions to the ophthalmic emergency unit through applying the best available evidences from quality literature for managing such conditions.


A retrospective cohort study at a tertiary eye care university hospital in Riyadh, Saudi Arabia, involving a two-phase audit of diagnosis–intervention was conducted. The first phase was done retrospectively for the duration from April 1 to May 30, 2014, after disseminating the results of the first phase to King Abdulaziz University Hospital ophthalmology department staff, and the second phase was done retrospectively for the duration from November 1 to December 30, 2015. The validity of outcomes was assessed through a literature search using Medline and the Cochrane Database of Systematic Reviews. The participants were masked on the study objectives to avoid Hawthorne’s phenomenon (prescribing bias).


In the first part of the audit, 73.2% out of 355 interventions were found to be evidence based. There was notable improvement of 80.9% in the number of evidence-based interventions in the second part of the audit. This improvement was statistically significant (p = 0.017).


Evidence-based medicine audit can be a helpful tool to assess the performance and can lead to quality improve of the provided care by reducing the number of medical errors and refining medical decisions and interventions.


Evidence-based medicine Ophthalmic emergency Audit 


Compliance with ethical standards

Conflict of interest

All the authors declare no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Rosenberg W, Donald A (1995) Evidence based medicine: an approach to clinical problem-solving. BMJ 310:1122–1126CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Sagoo MS, Raina J (2009) Evidence-based medicine audit as a tool for improving emergency ophthalmology. Eye (Lond) 23:368–375CrossRefGoogle Scholar
  3. 3.
    Ellis J, Mulligan I, Rowe J, Sackett DL (1995) Inpatient general medicine is evidence based. Lancet 346:407–410CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Smith R (1991) Where is the wisdom…? BMJ 303:798–799CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Lai TY, Wong VW, Leung GM (2003) Is ophthalmology evidence based? A clinical audit of the emergency unit of a regional eye hospital. Br J Ophthalmol 87:385–390CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Alotaibi AG, Osman EA, Allam KH, Abdel-Rahim AM, Abu-Amero KK (2011) One month outcome of ocular related emergencies in a tertiary hospital in Central Saudi Arabia. Saudi Med J 32:1256–1260PubMedPubMedCentralGoogle Scholar
  7. 7.
    Kingston R, Barry M, Tierney S, Drumm J, Grace P (2001) Treatment of surgical patients is evidence-based. Eur J Surg 167:324–330CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Michaud G, McGowan JL, van der Jagt R, Wells G, Tugwell P (1998) Are therapeutic decisions supported by evidence from health care research? Arch Intern Med 158:1665–1668CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Kenny SE, Shankar KR, Rintala R, Lamont GL, Lloyd DA (1997) Evidence-based surgery: interventions in a regional paediatric surgical unit. Arch Dis Child 76:50–53CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Gill P, Dowell AC, Neal RD, Smith N, Heywood P, Wilson AE (1996) Evidence based general practice: a retrospective study of interventions in one training practice. BMJ 312:819–821CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Jemec GB, Thorsteinsdottir H, Wulf HC (1998) Evidence-based dermatologic out-patient treatment. Int J Dermatol 37:850–854CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Myles PS, Bain DL, Johnson F, McMahon R (1999) Is anaesthesia evidence-based? A survey of anaesthetic practice. Br J Anaesth 82:591–595CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Bhatt R, Sandramouli S (2007) Evidence-based practice in acute ophthalmology. Eye (Lond) 21:976–983CrossRefGoogle Scholar
  14. 14.
    Baring DE, Hilmi OJ (2011) An evidence based review of periorbital cellulitis. Clin Otolaryngol 36:57–64CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Lee JS, Urschel DM, Urschel JD (2000) Is general thoracic surgical practice evidence based? Ann Thorac Surg 70:429–431CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Saw SM, Gazzard G, Friedman DS (2003) Interventions for angle-closure glaucoma: an evidence-based update. Ophthalmology 110:1869–1878 (quiz 1878-1869, 1930) CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Sun YJ, Li AP, Pan ZQ, Luo F, Zou LH (2010) Systematic review of penetrating keratoplasty rejection treated by immunosuppressants. Zhonghua Yan Ke Za Zhi 46:1122–1127PubMedPubMedCentralGoogle Scholar
  18. 18.
    Azari AA, Barney NP (2013) Conjunctivitis: a systematic review of diagnosis and treatment. JAMA 310:1721–1729CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Braithwaite T, Nanji AA, Lindsley K, Greenberg PB (2014) Anti-vascular endothelial growth factor for macular oedema secondary to central retinal vein occlusion. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD007325.pub3 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Pinar-Sueiro S, Sota M, Lerchundi TX, Gibelalde A, Berasategui B, Vilar B, Hernandez JL (2012) Dacryocystitis: systematic approach to diagnosis and therapy. Curr Infect Dis Rep 14:137–146CrossRefGoogle Scholar
  21. 21.
    Jackson TL, Paraskevopoulos T, Georgalas I (2014) Systematic review of 342 cases of endogenous bacterial endophthalmitis. Surv Ophthalmol 59:627–635CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Wilhelmus KR (2015) Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev 1:CD002898PubMedPubMedCentralGoogle Scholar
  23. 23.
    Evans JR, Michelessi M, Virgili G (2014) Laser photocoagulation for proliferative diabetic retinopathy. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD011234.pub2 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    van Bussel EM, van der Valk R, Bijlsma WR, La Heij EC (2014) Impact of duration of macula-off retinal detachment on visual outcome: a systematic review and meta-analysis of literature. Retina 34:1917–1925CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Blindbaek S, Grauslund J (2015) Prophylactic treatment of retinal breaks: a systematic review. Acta Ophthalmol 93:3–8CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Gharaibeh A, Savage HI, Scherer RW, Goldberg MF, Lindsley K (2013) Medical interventions for traumatic hyphema. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD005431.pub3 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Zhu D, Jin ZY, Tao Y, Jonas JB (2013) Meta-analysis of the effect of intravitreal bevacizumab in branch retinal vein occlusion. J Ocul Pharmacol Ther 29:523–529CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Coffee RE, Westfall AC, Davis GH, Mieler WF, Holz ER (2007) Symptomatic posterior vitreous detachment and the incidence of delayed retinal breaks: case series and meta-analysis. Am J Ophthalmol 144:409–413CrossRefPubMedCentralGoogle Scholar
  29. 29.
    de-la-Torre A, Stanford M, Curi A, Jaffe GJ, Gomez-Marin JE (2011) Therapy for ocular toxoplasmosis. Ocul Immunol Inflamm 19:314–320CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Beck RW, Cleary PA, Anderson MM Jr, Keltner JL, Shults WT, Kaufman DI, Buckley EG, Corbett JJ, Kupersmith MJ, Miller NR et al (1992) A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. the optic neuritis study group. N Engl J Med 326:581–588CrossRefGoogle Scholar
  31. 31.
    Doft BH, Wisniewski SR, Kelsey SF, Fitzgerald SG (2001) Diabetes and postoperative endophthalmitis in the endophthalmitis vitrectomy study. Arch Ophthalmol 119:650–656CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Menghini M, Knecht PB, Kaufmann C, Kovacs R, Watson SL, Landau K, Bosch MM (2013) Treatment of traumatic corneal abrasions: a three-arm, prospective, randomized study. Ophthalmic Res 50:13–18CrossRefGoogle Scholar
  33. 33.
    Wall M, McDermott MP, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, Katz DM, Keltner JL, Schron EB, Kupersmith MJ (2014) Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA 311:1641–1651CrossRefGoogle Scholar
  34. 34.
    Dawson CR, Margolis CR, Margolis TP, Nozik RA, Ostler HB, Barron BA, Wilhelmus KR (1996) A controlled trial of oral acyclovir for iridocyclitis caused by herpes simplex virus. Arch Ophthalmol 114:1065–1072CrossRefGoogle Scholar
  35. 35.
    Shah VM, Tandon R, Satpathy G, Nayak N, Chawla B, Agarwal T, Sharma N, Titiyal JS, Vajpayee RB (2010) Randomized clinical study for comparative evaluation of fourth-generation fluoroquinolones with the combination of fortified antibiotics in the treatment of bacterial corneal ulcers. Cornea 29:751–757CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Narang S, Gupta V, Gupta A, Dogra MR, Pandav SS, Das S (2003) Role of prophylactic intravitreal antibiotics in open globe injuries. Indian J Ophthalmol 51:39–44Google Scholar
  37. 37.
    Rothova A, Buitenhuis HJ, Meenken C, Brinkman CJ, Linssen A, Alberts C, Luyendijk L, Kijlstra A (1992) Uveitis and systemic disease. Br J Ophthalmol 76:137–141CrossRefPubMedCentralGoogle Scholar
  38. 38.
    Bayoumi NH (2012) Deep sclerectomy in pediatric glaucoma filtering surgery. Eye (Lond) 26:1548–1553CrossRefGoogle Scholar
  39. 39.
    Hutter H (1990) Epidemic keratoconjunctivitis: treatment results during an epidemic. Klin Monbl Augenheilkd 197:214–217CrossRefPubMedCentralGoogle Scholar
  40. 40.
    Tiffin PA, MacEwen CJ, Craig EA, Clayton G (1996) Acquired palsy of the oculomotor, trochlear and abducens nerves. Eye (Lond) 10(Pt 3):377–384CrossRefGoogle Scholar
  41. 41.
    Wu Z, Huang C, Huang Y, Zhang W, Ma D (2015) Soft bandage contact lenses in management of early bleb leak following trabeculectomy. Eye Sci 30:13–17PubMedPubMedCentralGoogle Scholar
  42. 42.
    Jabs DA, Mudun A, Dunn JP, Marsh MJ (2000) Episcleritis and scleritis: clinical features and treatment results. Am J Ophthalmol 130:469–476CrossRefPubMedCentralGoogle Scholar
  43. 43.
    Ehrlich R, Niederer RL, Ahmad N, Polkinghorne P (2013) Timing of acute macula-on rhegmatogenous retinal detachment repair. Retina 33:105–110CrossRefPubMedCentralGoogle Scholar
  44. 44.
    Bernauer W, Pleisch B, Brunner M (2014) Five-year outcome in immune-mediated scleritis. Graefes Arch Clin Exp Ophthalmol 252:1477–1481CrossRefPubMedCentralGoogle Scholar
  45. 45.
    Tetz MR, Klein U, Volcker HE (1997) Staphylococcus-associated blepharokeratoconjunctivitis. Clinical findings, pathogenesis and therapy. Ophthalmologe 94:186–190CrossRefPubMedCentralGoogle Scholar
  46. 46.
    Rishi E, Rishi P, Koundanya VV, Sahu C, Roy R, Bhende PS (2016) Post-traumatic endophthalmitis in 143 eyes of children and adolescents from India. Eye (Lond) 30:615–620CrossRefGoogle Scholar
  47. 47.
    Turner A, Rabiu M (2006) Patching for corneal abrasion. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD004764.pub2 CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Lindsley K, Nichols JJ, Dickersin K (2013) Interventions for acute internal hordeolum. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD007742.pub3 CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    McLeod SD, LaBree LD, Tayyanipour R, Flowers CW, Lee PP, McDonnell PJ (1995) The importance of initial management in the treatment of severe infectious corneal ulcers. Ophthalmology 102:1943–1948CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Department of Ophthalmology, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
  2. 2.Glaucoma Research Chair, Department of Ophthalmology, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
  3. 3.Department of Surgery, Ophthalmology DivisionKing Abdulaziz Medical CityRiyadhSaudi Arabia

Personalised recommendations