Non-contact tests for identifying people at risk of primary angle closure glaucoma.
PurposeIn recent years, there has been widespread investment in imaging technologies by community optometrists in the UK, most notably optical coherence tomography (OCT). The aim of the current study was to determine the value of OCT in the diagnosis of posterior segment diseases in a representative sample of community optometrists using a clinical vignette methodology.MethodsA group of community optometrists (n = 50) initially completed a standardised training package on OCT interpretation followed by a computer‐based assessment featuring 52 clinical vignettes, containing images of healthy (n = 8) or glaucomatous (n = 18) discs or healthy (n = 8) or diseased (n = 18) fundi. Each vignette featured either a single fundus/disc photographic image, or a combination of a fundus/disc image with the corresponding OCT scan. An expert panel confirmed that the fundus images presented alone and those in combination with OCT data were of a similar level of difficulty and that the cases were typical of those seen in primary care. For each case, the optometrist selected their diagnosis from a pull‐down list and reported their confidence in their decision using a 10‐point Likert scale. Pairwise comparisons of the fundus image alone and fundus image/OCT combination were made for both diagnostic performance and confidence.ResultsThe mean percentage of correct diagnoses using fundus imaging alone was 62% (95% CI 59–64%) and for the combination of fundus image/OCT was 80% (95% CI 77–82%). The mean false negative rate with fundus alone was 27% reducing to 13% with the OCT combination. Median confidence scores for fundus imaging alone was 8.0 (IQR 7.0–8.0) and 8.3 (IQR 8.0–9.0) for the combination. Improvements in performance and confidence were statistically significant (p < 0.001).ConclusionThe results from this vignette study suggests that OCT improves optometrists’ diagnostic performance compared to fundus observation alone. These initial results suggest that OCT provides valuable additional data that could augment case‐finding for glaucoma and retinal disease; however, further research is needed to assess its diagnostic performance in a routine clinical practice setting.
359 sibs from 92 families, where any one member of the family (basic unit of study) was found to be affected, were screened for myopia. Data on age at onset, parity and severity were studied in relation to consanguinity. Significant consanguinity differentials in the manifestation of myopia were seen. Offspring who were the product of a consanguineous mating manifested myopia more frequently as compared to the offspring from the non-consanguineous matings (control group). Males from consanguineous matings were affected in a higher frequency and manifested myopia at early ages. Myopia was found to be birth order-dependent. Pedigree analysis has shown that myopia is not a monogenic trait. The most plausible mode of inheritance of myopia seems to be polygenic with variable expressivity, and shows gene dosage effect.
This is the accepted version of the paper.This version of the publication may differ from the final published version. Methods: the study was divided into two phases. In the first phase, a random sample of 100 UK community optometrists were given an opportunity to select and grade eight digital slit-lamp images of anterior chamber angles using the original van Herick 4 point grading scale. The images were included in a clinical decision making study using computerized virtual case vignettes. In the second phase, hospitalbased glaucoma specialist optometrists and glaucoma sub-specialist ophthalmologists graded the LACD of the right eye using a 7 point % grading scale in 57 consecutively presenting patients with suspect glaucoma. Inter-observer agreement was assessed using linearly weighted kappa (κ w ). Permanent repository linkResults: inter-observer agreement for community optometrists was moderate, with a mean κ w for grading photographic images of 0.50 (95% confidence interval (CI) 0.43-0.57). Overall, ninety two percent of observations were within one grade of the actual grade, although grading of narrow angles was associated with a 13% false negative error rate (based on a ≤ grade 2 threshold). For phase 2 of the study, pairwise comparisons between optometrists and ophthalmologists showed that agreement was moderate to substantial (mean κ w =0.54-0.65) with a false negative rate of 1.9% (based on a ≤25% threshold). Grading accuracy of specialist optometrists and ophthalmologists were equivalent.Conclusions: In summary, the present study found that community optometrists showed moderate inter-observer agreement for grading LACD. Glaucoma specialist optometrists showed moderate to substantial agreement with weighted kappa values that were equivalent to sub-specialist ophthalmologists. The augmented 7 point % grading scale is intuitive and potentially offers greater accuracy for grading narrow angles than the traditional 4 point scale for grading LACD.
Non-contact methods for the detection of people at risk of primary angle closure glaucoma.
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