Dear Editor

Ramadan (the month of fasting for muslims) is approaching at the end of August 2009. As ophthalmologists in a centre with a large muslim population we read Kumar and Jivan's study with interest [1].

We agree that poor compliance with treatment can be improved with patient education. A major proportion of chronic ophthalmological disease monitoring is for glaucoma, first line treatment for which is latanoprost, administered in the evening. This does not interfere with fasting which ends after sunset. With the support of the ophthalmologist to remind the patient, drops that require twice daily use can be instilled before sunrise as patients who wish to fast are awake for an early breakfast (Suhur) and after sunset.

During Ramadan, muslim patients attend the eye clinic if they have an acute problem and will therefore comply with emergency treatment administered but are more likely to miss a routine eye clinic appointment for monitoring of chronic conditions [1-2]. This may be due to drops administered in the clinic essential for complete assessmen; according to the majority of muslim patients, eye drops constitute a breaking of the Ramadan fast [1-4]. Working in partnership with patients, asking when Ramadan is likely to be and arranging an appropriate follow up interval taking this into account has many advantages. It serves to strengthen the doctor-patient relationship and is outlined as a duty according to good medical practice [5].

Due to a large local muslim population it has been our practice for many years to consider the month of fasting when planning follow up appointments. As a result our "did not attend" (DNA) rates for muslim patients in the month of fasting are shown to be comparable to any other random month in the year. In 2008 the month of fasting was the month of September, facilitating data collection. The DNA rate in the glaucoma clinic for muslim patients was 27.3% in this month compared to 31.25% in the month of June 2008. For another glaucoma clinic the DNA rate was 25.7% compared to 34.7% (Ramadan September 08, June 08 respectively). In the diabetic clinic DNA rates were found to be 43.2% compared to 41.4%, showing poor attendance but that Ramadan is not significantly higher than another month of the year.

Our data suggests that a practical approach to booking routine follow up appointments for muslim patients, so they do not fall within the month of Ramadan, will have a positive impact on the DNA rate, an important way of increasing the efficiency of the ophthalmic service for all patients.

References

1. Kumar N, Dherani M, Jivan S. Ramdan and eye drops: perspective of Muslims in the UK. British Journal of Ophthalmology 2009; 93: 551

2. Kumar N, Jivan S. Ramadan and Eye Drops: the Muslim Perspective. Ophthalmology 2007; 114:2356-60

3. Moradi P. Ramadan and eyedrops: the muslim perspective. Ophthalmology. 2008 Aug;115(8):1440; author reply 1440-1.

4. Saha N. The attitudes and practice of Muslim patients using guttae medication during Ramadan. Eye. 2007;21(6):878-9.

5. Good Medical Practice. November 2006. (http://www.gms-uk.org)