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Duratul Ain Hussin, Andrew Carkeet, Peter Hendicott, Philip Baker, Ai-Hong Chen; Comparison of eye disease diagnosis by optometrists and ophthalmologists in Ampang, Malaysia. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5568.
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Optometrists in Malaysia receive a minimum of 4 years university training and have skills comparable with optometrists in many developed countries. However, as primary eye care clinicians, these optometrists’ skills are relatively underutilized. To assess the potential to improve health care efficiency, we assessed the diagnostic abilities of Malaysian-trained optometrists against ophthalmologists in detecting presence of cataract, diabetic retinopathy and glaucoma.
Two consultation rooms were set-up at a community clinic and a hospital eye clinic in Ampang, Malaysia. Eight optometrists and four ophthalmologists participated. Initially optometrists received a refresher course in diagnosis and management decision making for common eye diseases, and eye examination skills. Consecutive patients who gave written informed consent were initially examined by an optometrist and then re-examined by an ophthalmologist masked to the optometrist’s diagnosis.
Fifty-six patients participated, of whom, 42 patients had been already diagnosed with diabetes mellitus prior to recruitment to the study. Of these patients, 43 (86 eyes) were re-examined by an ophthalmologist and included in the analysis. Of these, 26 patients were known to have diabetes mellitus. Optometrists diagnosed cataracts in 37 eyes, diabetic retinopathy in 9 eyes and suspected glaucoma in 16 eyes. Ophthalmologists diagnosed cataracts in 39 eyes, diabetic retinopathy in 11 eyes and suspected glaucoma in 18 eyes. Diagnostic test characteristics and predictive values for optometrists diagnosis (compared with the standard of ophthalmologist diagnosis) for the three conditions are shown below.
In this study, Malaysian optometrists, even when inexperienced in primary eye care, could demonstrate high accuracy in detecting presence of a disease particularly cataract and glaucoma. However, based on the small number of cases detected by ophthalmologists (6 eyes), optometrists’ performance in detecting the presence of diabetic retinopathy was moderate. Better sensitivity may be achieved as Malaysian optometrists gain more experience with disease detection and diagnosis.
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