Neuro-Ophthalmology Referral Patterns: Learnings From Colombia

Background: There is a global shortage of neuro-ophthalmologists, driven by an aging workforce and declining interest among residents. Emerging data indicate that this supply-demand mismatch results in prolonged patient wait times, leading to evaluation by additional physicians, delayed/incorrect diagnosis, and postponed therapy. However, data on referral patterns are primarily from resource-rich countries. This study examines referral patterns for a neuro-ophthalmology clinic in Bogota, Colombia. Methods: A retrospective chart review analyzed patients referred to the clinic between July 2020 and July 2021. Data included demographics, time from symptom onset to neuro-ophthalmology appointment (NOA), referral-to-NOA time, initial specialty consulted, number of providers seen before NOA, diagnostic tests performed, and diagnoses at referral vs after NOA. Results: Among 535 patients (62.1% female), the median wait from symptom onset to NOA was 365 days (interquartile range [IQR]: 60–500) and 30 days ([IQR: 10–45]) from referral to NOA. Most patients (80.2%) first saw an ophthalmologist, with a mean of 1.1 providers seen before NOA. Common diagnostic tests before NOA included brain MRIs (28.6%), posterior segment optical coherence tomography (24.3%), and visual fields (22.8%). Three hundred twenty-six (63.9%) of patients were either partially or completely misdiagnosed before NOA. Time from symptom onset to NOA was a predictor for fully correct diagnosis by referring provider ( P < 0.01), with a shorter time corresponding to a greater likelihood of partially correct diagnosis. Conclusions: Referral delays are frequent, and misdiagnoses before neuro-ophthalmology consultations are common. Enhancing timely access to NOA could significantly improve patient outcomes and reduce unnecessary utilization of health care resources.