The British Ophthalmological Surveillance Unit: an evaluation of the first 3 years

Abstract

We report an evaluation of the British Ophthalmological Surveillance Unit (BOSU), a nationwide active surveillance scheme to assist with the case ascertainment of rare eye conditions. The evaluation assessed participation rates, study applications and research outputs. In addition, through an anonymous postal survey we ascertained the opinions of ophthalmologists regarding the usefulness, levels of feedback, barriers to participation and levels of case ascertainment. Over the first 3 years, the 4-month mean participation rate has improved from 58% to 71%. Ten studies have used this system for case ascertainment. To date three journal publications and 10 conference presentations have reported findings from these studies. It was observed that 582/870 (68%) questionnaires were returned by ophthalmologists, of whom 95% considered BOSU as very or quite useful. In all, 71% reported overall feedback to be sufficient. However, 34% requested greater feedback from research groups. Reported barriers to effective participation were 'having to remember the patient's identity' (52%) and paying for return postage of cards (22%). However, 72% of respondents did not consider the work involved in reporting a case to be prohibitive. Self-reported levels of case ascertainment by ophthalmologists for completed studies ranged between 72% and 95%. This population-based surveillance system provides an effective method for prospective case identification and subsequent data collection. It enables the study of sufficiently representative samples to allow meaningful epidemiological analysis and avoid bias. Its success relies upon the high level of support that it currently receives from ophthalmologists.

A British Ophthalmological Surveillance Unit study on serious ocular injuries from fireworks in the UK

“…The stated incidence should be considered as a minimum estimate, as some questionnaires have not been returned and other cases may not have been identified; however, previous similar studies ascertaining cases through the BOSU have reported ascertainment levels of 75-100%. 2 The BOSU achieved a mean monthly card return rate of 78% during the study period, which indicates a high level of compliance among reporting ophthalmologists. These factors coupled with the consistency of the number of case reports each year suggest it is likely that these data provide an accurate indication of the extent of visual morbidity caused by severe firework injuries.…”

“…New cases of serious ocular injuries from fireworks were prospectively ascertained through the monthly active surveillance system of the British Ophthalmological Surveillance Unit (BOSU). 2 Through the BOSU all ophthalmologists with clinical autonomy in the UK are sent a reporting card each month and asked to indicate new cases of conditions of interest, or to confirm that they had no new cases to report. Serious ocular injuries from fireworks were included on the BOSU card from July 2004 to June 2006.…”

Surveillance of intraocular foreign bodies in the UK

“…Previous reports for studies ascertaining cases through the BOSU have indicated that ascertainment rates usually lie between 75 and 95%. 15 Although not directly linked to ascertainment, response rates are the most common method for assessing underascertainment. 18 The proportion of non-duplicate cases of IOFB that met the inclusion criteria is 97/134 (72%).…”

“…Underascertainment of cases could be due to random errors (eg forgetting to report a case), reluctance to participate in the BOSU reporting scheme (barriers to participation have previously been reported 15 ), or management of cases by non-consultant ophthalmologists (who do not receive BOSU reporting cards). To adequately assess completeness of reporting, an alternative routine source to identify all cases would be necessary, but none was available.…”

“…15 The BOSU was established to facilitate research into rare eye conditions with significant public health or scientific importance. Individual investigators submit proposals to BOSU for conditions to be surveyed and the BOSU steering committee determines which conditions will be surveyedFusually three or four at any particular time.…”