Abstract
Purpose :
In 2016 following the conviction for manslaughter of an optometrist for failing to identify a child with papilloedema, who subsequently died, ophthalmology units in the UK have seen a marked rise in false positive referrals of cases of suspected papilloedema. Virtual clinics have been set up to help to cope with workload. Through the design and circulation of our survey we aimed to: 1) evaluate the knowledge and understanding within different groups (i.e. optometrists, medics, and students) and compare them, 2) to address: does the presence of symptoms accompanying a case presentation influence/change clinical decision making? 3) What is the global perspective and 4) ultimately, to get meaningful data that can be used to educate/train.
Methods :
20 clinical questions pertaining to disc images were included in our survey. 10 conditions were presented, with each presented twice, once with symptoms and once without (figure 1). Cases included were of papilloedema and pseudopapilloedema. Other questions asked: do you look for spontaneous venous pulsations and does the Honey Rose case (optometrist convicted of manslaughter) influence your practice when dealing with suspect swollen optic nerves? The survey was distributed globally.
Results :
n=432 responses were received in total (n=385 from the UK and n=47 from the rest of the world (8 countries in total)). Performance was similar across the world. Optometrists (OO's) with >5 years of experience represented 48% of the responders. In terms of correct responses recorded (figure 2) paediatric consultant ophthalmologists scored 90.8%, followed by OO's >5 years of experience 89.7% and then OO's <5 years of experience 89.3%. Sub-group analysis revealed statistically significant differences (Chi-Squared test) between OO's >5 years of experience and 3rd year optometry students (p = 0.0033) and OO's <5 years of experience and 3rd year optometry students (p = 0.041). Statistically significant differences were noted (p=0.000000016) when cases were presented with symptoms (78% correct responses overall) compared to without (94% correct responses overall). Over half of OO's stated that the Honey Rose (HR) case influences their clinical practice.
Conclusions :
OO's are more than capable at detecting if an optic nerve head is swollen, but in a world first, we have demonstrated that the HR case, the presence of symptoms and a lack of experience influence clinical judgement & decision making and results in inappropriate referrals.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.