Evaluation of a clinical decision-making aid for nutrition advice in age-related macular degeneration

Abstract

Age-related macular disease (AMD) is a multifactorial degenerative condition affecting the central area of the retina. Patients with AMD report that eye care practitioners are not giving consistent advice regarding nutrition and reported confusion as to what advice, if any, to follow. The aim of this study was to design and conduct a preliminary evaluation of a flowchart to support eye care practitioners in providing accurate, evidence-based nutritional advice to their patients. A flowchart was designed to take practitioners through a decision-making process that would determine whether a patient matched the Age-Related Eye Disease Study (AREDS) 2 eligibility criteria for supplementation. The flowchart was evaluated using a qualified and student optometrist cohort, with both cohorts completing confidence scales and students completing clinical scenarios. Qualified participants showed a significant increase in confidence scores from the initial survey (M = 69.7%, standard deviation [SD] = 16.2%) to the second survey after use of the flowchart for 2 weeks (M = 82.1%, SD = 11.6%; t(45) = 7.33, p < .001; rs = .61, p < .001). The student participants also increased confidence scored after receiving the flowchart (M of first survey = 41.7, SD = 14.6; M of second survey = 69.1, SD = 1.7; t(25) = 7.92, d = .81, p < .001) and increased the number of correct answers on five clinical scenarios. Overall, the flowchart has proved to be useful in boosting the self-efficacy of both qualified practitioners and student practitioners, as well as improving clinical decisions made by student practitioners.

Patient experience of treatment decision making for wet age-related macular degeneration disease: a qualitative study in China

“…PDAs can be used to show the advantages and disadvantages of different options, to help patients understand their values and preferences and to make the most suitable decision after discussion with the medical staff 32. Although PDAs for cataract surgery,33 primary open-angle glaucoma34 and nutrition advice for AMD35 have been developed and used in some foreign counties, there was no PDA available in the field of ophthalmological medicine in China. Therefore, how to normatively introduce foreign decision-making aids from other countries and scientifically develop our own PDAs was a very important and urgent problem to deal with in the near future.…”

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

“…This theme included education of eyecare providers, people with AMD and the general public (S3 Table) but the focus groups did not provide any insights on the potential design, feasibility and effectiveness of these educational interventions. One such example might be a clinical decision-making tool in the form of a flowchart, which was recently shown to aid qualified and student optometrists in the UK match patients to the AREDS 2 eligibility criteria [41]. The “nutrition advice for people with, or at risk of AMD” clinical decision-making tool was shown to increase practitioner confidence and lead to improved student optometrist performance on five hypothetical clinical scenarios [41].…”

Dietary zinc intake is associated with macular fluid in neovascular age‐related macular degeneration

“…Currently, however, there are no robust epidemiological data on associations between dietary parameters and clinical or treatment outcomes in patients with nAMD . These data are particularly important given that eye‐care clinicians are giving inconsistent lifestyle advice to AMD patients; and there remains confusion or uncertainty of what nutritional advice to follow from a patients' perspective …”