Collaborative care of non‐urgent macular disease: a study of inter‐optometric referrals

Ly, Angelica; Nivison‐Smith, Lisa; Hennessy, Michael; Kalloniatis, Michael

doi:10.1111/opo.12322

Cited by 18 publications

(22 citation statements)

References 43 publications

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“…The overall accuracy of optometry diagnosis was low as 63% of referrals to this clinic did not have macular degeneration [37]. Conversely, in a retrospective review of patients records and referrals for macular disease at a diagnostic imaging centre in Australia, excellent diagnostic congruency between the optometric referral and the centre was observed with 47 of 50 or 94% of cases correctly diagnosed by the referring optometrist [38]. A lack of trust between optometrists and ophthalmologists in Australia was identified as a fundamental issue to address [31].…”

Section: Discussionmentioning

confidence: 99%

A qualitative exploration of eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care

Jalbert

Rahardjo²,

Yashadhana³

et al. 2018

Preprint

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18Despite the existence of evidence-based recommendations to decrease risk and progression of Age-19 Related Macular Degeneration (AMD) for some time, self-reported practices suggest that eyecare 20 professionals' advice and people with AMD's adherence to these recommendations can be very 21 poor. This study uses qualitative methods to explore Australian eyecare professionals' perspective 22 34Factors impacting AMD care identified through analysis of the transcripts were coded to three 35 categories of influence: patient-centered, practitioner-centered, and structural factors. Eyecare 36 professionals considered poor care pathways, people with AMD's poor disease understanding / 37 denial, and cost of care / lack of funding, as the most significant barriers to AMD care; they 38 considered shared care model, access, and communication as the most significant enablers to good 39 AMD care. These findings suggest that Australian eyecare professionals perceive that there is a need 40 for improved patient support systems and appropriately funded, clearer care pathway to benefit 41 people with AMD.3 42 65 although no consistent pattern could be detected [9]. Comparative data on Australian 66 ophthalmologists was unfortunately not collected.

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Section: Discussionmentioning

confidence: 99%

A qualitative exploration of eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care

Jalbert

Rahardjo²,

Yashadhana³

et al. 2018

Preprint

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“…Services offered by CFEH have been explained elsewhere . Within a Glaucoma Suite, a battery of glaucoma‐related tests (Table ) are performed for the patient, and a final diagnosis and recommended management are provided.…”

Section: Methodsmentioning

confidence: 99%

“…2,4,14 Services offered by CFEH have been explained elsewhere. 5,6,18,19 Within a Glaucoma Suite, a battery of glaucoma-related tests ( Table 1) are performed for the patient, and a final diagnosis and recommended management are provided. For the purpose of this study, the files of patients who had received an initial referral for a Glaucoma Suite were extracted.…”

Section: Cfeh Clinical Protocolsmentioning

confidence: 99%

A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

Phu

Hennessy

Spargo

et al. 2020

Clinical and Experimental Optometry

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Background Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease. Methods The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted. Results Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non‐angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001). Conclusions The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities.

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“…A minimum of 51 images was needed to detect a statistically significant difference of 20% in performance; between the two diagnostic methods with 95% confidence and 80% power . For the sample size calculation, a median specificity of 74% was assumed based on previous studies involving community optometrists in detecting glaucomatous discs using disc images . For the number of participants making a clinical decision, a formal sample size calculation was not performed.…”

Section: Methodsmentioning

confidence: 99%

“…22 For the sample size calculation, a median specificity of 74% was assumed based on previous studies involving community optometrists in detecting glaucomatous discs using disc images. [23][24][25] For the number of participants making a clinical decision, a formal sample size calculation was not performed. However, we aimed to recruit a suitable number of community-based optometrists who are representative of those working in the UK.…”

Section: Sample Sizementioning

confidence: 99%

Impact of optical coherence tomography on diagnostic decision‐making by UK community optometrists: a clinical vignette study

Jindal

Ctori

Fidalgo

et al. 2019

Ophthalmic Physiologic Optic

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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.

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Collaborative care of non‐urgent macular disease: a study of inter‐optometric referrals

Cited by 18 publications

References 43 publications

A qualitative exploration of eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care

A qualitative exploration of eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care

A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

Impact of optical coherence tomography on diagnostic decision‐making by UK community optometrists: a clinical vignette study

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