Self‐reported optometric practise patterns in age‐related macular degeneration

Ly, Angelica; Nivison‐Smith, Lisa; Zangerl, Barbara; Assaad, Nagi; Kalloniatis, Michael

doi:10.1111/cxo.12528

Cited by 11 publications

(15 citation statements)

References 44 publications

(50 reference statements)

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“…4 Several factors contribute to the difficulty and a lack of uniformity in AMD assessment. 5 The condition is phenotypically heterogeneous. Evaluation of clinical markers for determining AMD stage and risk of progression (drusen size, pigmentary abnormalities), using funduscopy and/or retinal photography, may also vary between clinicians.…”

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confidence: 99%

Multispectral Pattern Recognition Reveals a Diversity of Clinical Signs in Intermediate Age-Related Macular Degeneration

Nivison‐Smith

Assaad

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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confidence: 99%

Multispectral Pattern Recognition Reveals a Diversity of Clinical Signs in Intermediate Age-Related Macular Degeneration

Nivison‐Smith

Assaad

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…In the UK and internationally, there has been a shift towards integrating advanced imaging technologies, particularly OCT, into routine case finding 25–28. Global interest in the value of SD-OCT for detecting retinal disease has recently been fuelled further by the application of artificial intelligence (AI) based on deep learning algorithms 29 30.…”

Section: Discussionmentioning

confidence: 99%

Role of advanced technology in the detection of sight-threatening eye disease in a UK community setting

et al. 2019

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Background/aimsTo determine the performance of combinations of structural and functional screening tests in detecting sight-threatening eye disease in a cohort of elderly subjects recruited from primary care.Methods505 subjects aged ≥60 years underwent frequency doubling technology (FDT) perimetry, iVue optical coherence tomography (iWellness and peripapillary retinal nerve fibre layer (RNFL) scans) and intraocular pressure with the Ocular Response Analyzer, all performed by an ophthalmic technician. The reference standard was a full ophthalmic examination by an experienced clinician who was masked to the index test results. Subjects were classified as presence or absence of sight-threatening eye disease (clinically significant cataract, primary open-angle glaucoma, intermediate or advanced age-related macular degeneration and significant diabetic retinopathy). Univariate and multivariate logistic regression analyses were used to determine the association between abnormal screening test results and the presence of sight-threatening eye disease.Results171 subjects (33.8%) had one or more sight-threatening eye diseases. The multivariate analysis found significant associations with any of the target conditions for visual acuity of <6/12, an abnormal FDT and peripapillary RNFL thickness outside the 99% normal limit. The sensitivity of this optimised screening panel was 61.3% (95% CI 53.5 to 68.7), with a specificity of 78.8% (95% CI 74.0 to 83.1), a positive predictive value of 59.5% (95% CI 53.7 to 65.2) and an overall diagnostic accuracy of 72.9% (95% CI 68.8 to 76.8).ConclusionsA subset of screening tests may provide an accurate and efficient means of population screening for significant eye disease in the elderly. This study provides useful preliminary data to inform the development of further larger, multicentre screening studies to validate this screening panel.

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“…In the UK, and internationally, there has been a shift towards integrating advanced imaging technologies, particularly optical coherence tomography (OCT), into routine optometric practice . However, it is not clear whether the incorporation of advanced imaging leads to an improved diagnostic performance.…”

Section: Introductionmentioning

confidence: 99%

“…7 In the UK, and internationally, there has been a shift towards integrating advanced imaging technologies, particularly optical coherence tomography (OCT), into routine optometric practice. [12][13][14][15] However, it is not clear whether the incorporation of advanced imaging leads to an improved diagnostic performance. A recent study in Australia using case vignettes found that the diagnostic accuracy of macular disease is only marginally improved with the incorporation of advanced imaging techniques compared to colour fundus photography alone; the additional information from advanced imaging led to increased numbers of false positives and a greater tendency to refer cases to secondary care.…”

Section: Introductionmentioning

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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Self‐reported optometric practise patterns in age‐related macular degeneration

Cited by 11 publications

References 44 publications

Multispectral Pattern Recognition Reveals a Diversity of Clinical Signs in Intermediate Age-Related Macular Degeneration

Multispectral Pattern Recognition Reveals a Diversity of Clinical Signs in Intermediate Age-Related Macular Degeneration

Role of advanced technology in the detection of sight-threatening eye disease in a UK community setting

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

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