Pattern of ophthalmic referral from primary healthcare centres to secondary and tertiary hospitals in Qassim Province, Saudi Arabia


  • Dora Hamad AlHarkan Department of Ophthalmology, Medical College, Qassim University, Qassim, Saudi Arabia
  • Rawan Mohammed A. Altowayan Department of Ophthalmology, Medical College, Qassim University, Qassim, Saudi Arabia
  • Amjad Mohammed Alharbi Department of Ophthalmology, Medical College, Qassim University, Qassim, Saudi Arabia
  • Sahar Mohammed Aljumaiah Department of Ophthalmology, Medical College, Qassim University, Qassim, Saudi Arabia
  • Lamia Ibrahim Alhijji Department of Ophthalmology, Medical College, Qassim University, Qassim, Saudi Arabia
  • Buthaina Suliaman B. Alkhezzy Department of Ophthalmology, Medical College, Qassim University, Qassim, Saudi Arabia



Primary eye care, Primary health care, Ophthalmic references


Background: References of patients with ocular diseases are an indirect indicator that reflects integration of primary eye care into primary health care system. The study reviewed the ophthalmic references from four randomly selected primary health care centres to ophthalmic unit of secondary and tertiary hospitals in Qassim Province of Saudi Arabia.

Methods: This was a retrospective health record review study was undertaken at four PHC centres in Qassim region during the year 2017. All cases referred for eye care from January 2015 until December 2016 were included. Prevalence of ophthalmic reference, profile of ophthalmic patients and ophthalmic diagnosis were analysed.

Results: From primary health care centres, 423 eye cases from 1,387,996 population of catchment area were referred. The annual prevalence of eye reference was 1.5 per 10,000. Vision screening and diabetic retinopathy evaluation comprised of 55.5% of total reference.

Conclusions: Poor reference pattern from primary health care centers to secondary and tertiary eye centre suggest urgent and strong need of implementing primary eye care in the primary health care centres of Saudi Arabia. Referral of simple eye cases are increasing the workload of ophthalmologists and can delay urgent referrals like cases of diabetic retinopathy screening.


Saudi Vision 2030. Available at: Accessed on 1 January 2018.

Griggs D, Smith SM, Gaffney O, Rockstrom J, Ohman MC, Shyamsundar P, et al. Policy: Sustainable development goals for people and planet. Nature. 2013;495(7441):305-7.

World Health Organization. Summary report on ‘Regional workshop for integrating and strengthening primary eye care within primary health care in the Eastern Mediterranean Region.’ 2011. Available at: http://applications. Accessed on 2 January 2018.

Eastern Mediterranean Region works towards Universal Eye Health in ‘Global Action Plan - Eastern Mediterranean’. Available at: Accessed on 2 January 2018.

Daghri ANM, Attas AOS, Alokail MS, Alkharfy KM, Yousef M, Sabico SL, et al. Diabetes mellitus type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): a decade of an epidemic. BMC Med. 2011;9:76.

Alaboud AF, Tourkmani AM, Alharbi TJ, Alobikan AH, Abdelhay O, Batal ASM, et al. Microvascular and macrovascular complications of type 2 diabetic mellitus in Central, Kingdom of Saudi Arabia. Saudi Med J. 2016;37(12):1408-11.

Naidoo KS, Leasher J, Bourne RR, Flaxman SR, Jonas JB, Keeffe J, et al. Global vision impairment and blindness due to uncorrected refractive error, 1990-2010. Optometry Vision Sci. 2016;93(3):227-34.

Evans JR, Morjaria P, Powell C. Vision screening for correctable visual acuity deficits in school-age children and adolescents. Cochrane Database Syst Rev. 2018;2:CD005023.

Yasir ZH, Khandekar R, Benaeem AS. Prevalence and determinants of refractive error and related ocular morbidities among Saudi adolescence population in Riyadh, Saudi Arabia. MEAJO. 2019;35(2):394-8.

Qesair AHF, Alshammari A. Parent’s Perceptions towards the Role of School Health Units at Early Detection of Ocular Disorders among Students in Qassim Province, Saudi Arabia. MJSS. 2016;7(4):198.

Arenas E, Armas G, Ramirez A. Pinguecula. PAAO. 2019;1(1):9.

Ghamdi AM. Accuracy of diagnosis of eye diseases referred by primary health-care physicians in Jeddah City, Saudi Arabia. Int J Med Sci Public Health. 2018;7(6):493-9.

Oman and Wold Health Organization. Eye Health Care Program: Ministry of Health; ‘Eye Health Care Manual. 2nd edition. 2000.

Ministry of Health the Statistical year Book 1437. Population proportion of Saudi by age group. Available at: Ministry/Statistics/book/Documents/Statistical-Yearbook-1437H.pdf. Accessed on 10 January 2018.

Aldebasi YH. Prevalence of amblyopia in primary school children in Qassim province, Kingdom of Saudi Arabia. Middle East Afr J Ophthalmol. 2015;22(1):86-91.

International Agency for the Prevention of Blindness - EMR. Guidelines for school eye health for eastern Mediterranean region (EMR). 2009:10. Available at: Accessed 29 January 2018.

Rim TH, Choi M, Yoon JS, Kim SS. Sociodemographic and health behavioural factors associated with access to and utilisation of eye care in Korea: Korea Health and Nutrition Examination Survey 2008-2012. BMJ Open. 2015;5(7):7614.

Khandekar R, Mohammed AJ. Gender inequality in vision loss and eye diseases: evidence from the Sultanate of Oman. IJO. 2009;57(6):443.

Mganga H, Lewallen S, Courtright P. Overcoming gender inequity in prevention of blindness and visual impairment in Africa. MEAJO. 2011;18(2):98.

MODON. Al-Qassim 2nd industrial city. Available at

IndustrialCitiesDirectory/IndustrialCities/Pages/AlQassim2nd.aspx. Accessed on 10 January 2018.

Uzma N, Kumar BS, Salar BK, Zafar MA, Reddy VD. A comparative clinical survey of the prevalence of refractive errors and eye diseases in urban and rural school children. CJO. 2009;44(3):328-33.

World Health Organization. Universal Health Coverage. Available at: Accessed on 6 November 2019.






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