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Samantha Slotnick, Daniel Epshtein, Catherine Awad, Sanjeev Nath, Jerome Sherman; iVue® iWellnessExam™ Retains Highs Sensitivity & Specificity Among Novice Reviewers. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1445.
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To assess the specificity (SP) & sensitivity(SN) of the iWellnessExam™(iWE) screening protocol (available on iVue® Spectral Domain Optical Coherence Tomography (SD-OCT), Optovue, Inc., Fremont, CA), when reviewed by novice technicians with a range of ophthalmological experience, in a cohort of Confirmed Normal (CN) & Confirmed Disease (CD) subjects.
A distinguished teaching professor with expertise in ophthalmological technology provided a brief lecture on the interpretation of iVue® iWE findings to a set of 4 novices in the ophthalmological field: A non-optometric technician, a pre-1st yr optometry student with 1 yr ophthalmology technician experience, a 1st-yr & a 3rd-yr optometry student. The OD, OS & OU iWE findings of 126 CN subjects & 101 CD subjects were then independently reviewed and sorted into one of four categories: (c1=Normal, c2=Retinal disease, c3=Optic Nerve (ON) disease, c4=Retinal+ON disease). SP & SN of the iWE screening is compared across the novice reviewers & expert reviewer.
As a group, the novices were better able to detect disease than to confirm health (SN>SP). Collectively, they were better at detecting confirmed ON disease (COD) than confirmed retinal disease (CRD). Retinal &/or ON disease was properly detected in 90.6% of CDs (c2, c3 & c4, SN range 81.2 to 94.0%), 84.3% of CRD (c2 & c4, SN range 74.6 to 88.0%), & 88.0% of COD (c3 & c4, SN range 76.0 to 96%) by the novices. (Compare with expert SN= 96.0%, 95.5%, 90.0%, respectively.) Novices confirmed health in 84.3% CNs, collectively (SP range 78.6 to 91.3%). (Compare with expert SP=99.2%.) Overall disease & CRD SN improved with academic experience level. However, novices demonstrated a marked tendency to over-refer within the disease population, flagging subjects in either c2 or c3 as c4. Retinal disease over-referrals in patients with ON disease abates somewhat with optometric education, but ON disease over-referral remains elevated in patients who have retinal disease.
The iWE offers the health care provider an excellent screening method for identifying eyes at risk with a very reliable technology. High SP & SN are obtained with both expert & novice reviewers. The tendency to over-refer for retinal disease in patients with ON disease decreases with education & experience. The challenge of over-referral for ON disease in patients with retinal disease remains high.
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