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AV Datta, RV North, JM Wild, JE Morgan; Screening of Glaucoma Referrals: the optometrist-led digital-imaging clinic . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3432.
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Purpose:To determine the diagnostic outcome of an optometrist-led clinic for the screening of glaucoma referrals to the Hospital Eye Service. Methods:Six optometrists were trained to perform ophthalmic examination of patients referred to the Hospital Eye Service as glaucoma suspects. In each patient, optic discs were imaged by sequential digital stereoscopic fundus photography and scanning laser ophthalmoscopy (HRT II). Visual fields were determined by SITA Fast perimetry (Humphrey Visual Field Analyzer). The outcome of the ophthalmic examination was prospectively documented, in detail, using an electronic patient record. The diagnosis made by each optometrist was reviewed by two experts to quantify diagnostic accuracy. Results:The records of 82 consecutively presenting patients were reviewed. Patients were diagnosed in the following categories (% of total) for the optometrists (experts). Normal, 23.2 (29.3), Suspect 24.4 (17.1), Ocular hypertension 4.9 (7.3), Glaucoma 43.9 (43.9). Factors influencing expert diagnosis (% of cases) were Optic Disc (96.6), IOP (69.3), Visual Field (62.5). Agreement between the optometrists and experts in diagnosis was moderate to good as measured using the kappa statistic; normal 0.65, suspect 0.34, OHT 0.58, glaucoma 0.70. No false-negative glaucoma diagnoses were made by the optometrists; false-positive glaucoma diagnoses were made in 3% of cases. Conclusion:The agreement between optometrists and experts was good for the diagnosis of normal and glaucoma patients but moderate for the differentiation of suspects and OHTs. Importantly, examination of the optic disc played a greater role in confirming diagnosis than the visual field.
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