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Angelica Ly, Lisa Nivison-Smith, Barbara Zangerl, Michael Kalloniatis; Practice patterns in age-related macular degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2016;57(12):3701. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The routine role of advanced imaging in clinical practice is emerging. This study explored the perceived utility of advanced imaging in AMD and contemporary practice patterns regarding AMD diagnosis and management using a cross-sectional survey of optometrists in Australia and New Zealand.
A survey was distributed to practicing optometrists using an online tool, Survey Monkey. The survey focused on five key areas: 1) demographics, 2) clinical skills and experience, 3) assessment of AMD, 4) AMD management, and 5) evidence based practice. Questions pertaining to competency, knowledge and attitudes used a 5-point Likert scale. The survey was anonymous and no incentives were offered. A minimum 178 responses were required to represent the 4752 and 690 practicing optometrists in Australia and New Zealand respectively at a 95% confidence level with a 10% confidence interval.
283 responses were received. Respondents reported practice experience of 1 to 57 equivalent full time years and average workloads of 4 days per week, seeing 10 patients daily. Average exposure to AMD cases was 11% or 4 patients per week. 64% of respondents expressed above average or excellent competency in diagnosing and managing AMD and performing traditional techniques such as slit lamp funduscopy. Advanced imaging however showed greater variation in service delivery and trended towards optical coherence tomography (OCT) which was routinely performed in AMD by 48% of respondents. OCT was also associated with higher test competency, knowledge scores and perceived relevance to practice than other modalities: modified retinal photography and fundus autofluorescence. For management of AMD, almost all respondents (>90%) applied case history, visual function and traditional testing while 67% applied signs from advanced imaging, 66% applied the AMD stage, 58% applied clinical guidelines and 26% applied risk calculators. 52% rated nutritional supplements as relevant in early AMD and normal aging changes, contrary to the evidence base.
In health systems where optometrists provide primary eye care, a suitable level of diagnostic accuracy and evidence based management is required. These results highlight a clinical paradigm shift toward advanced imaging and the use of OCT in the optometric assessment of AMD. This work will be useful in healthcare planning and guide the development of teaching curriculums.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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