Leber Hereditary Optic Neuropathy (LHON): Online medical education can significantly improve physicians’ diagnostic competence and confidence, and improve therapy knowledge

Abstract

Purpose : To determine if online medical education for ophthalmologists (Oph) and neurologists (Neu) could improve competence and confidence for the assessment and management of LHON patients

Methods : Oph and Neu participated in a clinical practice assessment (CPA) of 25 questions and 4 accredited online videos and text-based, educational activities of 15-75 minutes duration with downloadable slides/ transcripts, made available on an independent membership-based platform. Learners accessed min 1/5 activities. Repeated pairs pre-/post-assessment study design was used for each of the 4 programs, assessing 3 multiple choice knowledge or competence and one confidence question for each activity, which were aligned to the identified learning needs. Statistical significance tests: McNemar’s test for individual questions (5% significance level, P <.05), paired sample t-test for overall average correct responses and confidence rating; data collected from Dec 2020 - Apr 2022. Test completers: 7,141

Results : The CPA (Oph n=1033, Neu n=445) identified knowledge gaps in LHON inheritance and clinical presentation. 60% of participants self-rated as entirely unfamiliar with LHON. 34%Oph/ 57% Neu were unfamiliar with its existing and emerging therapies. 63%Oph/60% Neu ordered genetic testing. Across the 4 activities, both Oph (n=1140-1276) and Neu (n=332-371) significantly increased their competence in recognising LHON and making a diagnosis by correctly answering questions applying to patient scenarios. Knowledge of LHON therapy management also improved significantly for both Oph (n=448-1170) and Neu (n=146-403). 67%Oph (n=448) and 60% Neu (n=146) significantly gained confidence when to order genetic testing.

Conclusions : Online medical education based on clinician knowledge and self-assessment, using complementing educational formats, is effective in improving competence and confidence when assessing suspected LHON patients. It can increase knowledge on current and emerging therapies. This is valuable to shorten time to a confirmed LHON diagnosis, including the identification of the causative mutations, to allow patients to benefit from specific therapies in development, in particular, gene therapy. Further education is warranted to disseminate latest clinical data on therapies and evidence-based patient selection guidance for clinical practice.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.