Validity and reliability of eye healthcare professionals in the assessment of glaucoma - a systematic review

Results of a Glaucoma Shared Care Model Using the Enhanced Glaucoma Staging System and Disc Damage Likelihood Scale with a Novel Scoring Scheme in New Zealand

Purpose

To report the results of a scheme sharing follow-up glaucoma consultations between community optometrists and secondary care in a hospital ophthalmic clinic.

Patients and Methods

Optometrists measured intraocular pressure (IOP) with Goldmann Tonometry, graded the optic disc with the Disc Damage Likelihood Score (DDLS) and graded visual field tests with the enhanced Glaucoma Staging Score (eGSS). A scoring system from these tests was applied, and patients were either seen routinely 6 months later within the scheme or returned non-routinely to secondary care. Appointments within the scheme were 6-monthly with the pattern of three community optometrist visits then one hospital clinic visit.

Results

Community optometrists conducted 529 appointments for 285 patients. A total of 114 patients were seen after non-routine return to secondary care, with 61 true positives (53.5%) and 53 false positives (46.5%). Forty-one patients (14.4%) developed glaucoma progression, and 18 patients (6.3%) developed new non-glaucomatous ophthalmic diseases. Fifty-two patients were seen at 2 years after the routine return to secondary care, and three had glaucoma progression, with scheme specificity of 94.2%. The overall false-positive returns to secondary care from eGSS alone was 7.4%, and from the DDLS was 0.01%.

Conclusion

The DDLS and eGSS performed well for this population and would be recommended for use in shared care schemes, and the scoring scheme fulfilled its clinical and clerical purposes. Secondary care appointments are recommended in shared care schemes to manage the expected comorbidities and glaucoma progression, and prevent sight loss from false negatives.

[Baseline diagnostics and initial treatment decision for anti-vascular endothelial growth factor treatment in retinal diseases : Comparison between results by study physician and reading centers (ORCA/OCEAN study)]

BACKGROUND

The ORCA module of the non-interventional OCEAN study investigated the use of retinal imaging diagnostics in the clinical treatment of patients undergoing vascular endothelial growth factor (VEGF) inhibitor treatment as part of routine clinical care. This article analyzes the agreement between the diagnosis documented by the treating ophthalmologist and the evaluation of reading centers at baseline as well as the effect on the response to treatment during the course.

METHODS

A total of 396 patients (age 75.4 years) were enrolled in which ranibizumab treatment was indicated by the treating ophthalmologist due to either diabetic macular edema (DME), neovascular age-related macular degeneration (nvAMD) or retinal venous occlusion (RVO). Over a period of 24 months, patient and examination data, treatments and interpretation of retinal imaging data by the treating ophthalmologist were systematically recorded. Furthermore, retinal imaging data were also evaluated by three reading centers.

RESULTS

In 338 out of 396 (85.4%) study eyes, the baseline diagnosis of the treating ophthalmologist was confirmed by the reading centers (DME 87.5%, nvAMD 82.3%, RVO 94.9%). In 17 of the remaining 58 eyes with a discrepant diagnosis, there was at least a consensus with respect to the indications for VEGF inhibitor therapy. The differential diagnoses included a variety of different retinal diseases. During follow-up of up to 3 months, eyes with a consistent diagnosis showed a clear increase in visual acuity (6.4 versus 2.7 letters, p = 0.05) and greater decrease in central retinal thickness (-112.3 versus -24.4 μm, p < 0.0001).

DISCUSSION

The initial treatment decision for anti-VEGF therapy with consideration of the differential diagnoses can be challenging. Accurate evaluation of the clinical and imaging findings along with appropriate expertise appear to be important. The observation of superior initial response in eyes with a consensus of the diagnosis at baseline underlines the relevance of an adequate initial assessment for a successful treatment outcome.

Capability of Ophthalmology Residents to Detect Glaucoma Using High-Dynamic-Range Concept versus Color Optic Disc Photography

BACKGROUND

Assessment of color disc photograph (C-DP) is affected by image quality, which decreases the ability to detect glaucoma. High-dynamic-range (HDR) imaging provides a greater range of luminosity. Therefore, the objective of this study was to evaluate the capability of ophthalmology residents to detect glaucoma using HDR-concept disc photography (HDR-DP) compared to C-DP.

DESIGN

Cross-sectional study.

METHODS

Twenty subjects were classified by 3 glaucoma specialists as either glaucoma, glaucoma suspect, or control. All C-DPs were converted to HDR-DPs and randomly presented and assessed by 10 first-year ophthalmology residents. Sensitivity and specificity of glaucoma detection were compared.

RESULTS

The mean ± SD of averaged retinal nerve fiber layer (RNFL) thickness was 74.0 ± 6.1 μm, 100.2 ± 9.6 μm, and 105.8 ± 17.2 μm for glaucoma, glaucoma suspect, and controls, respectively. The diagnostic sensitivity of HDR-DP was higher than that of C-DP (87% versus 68%, mean difference: 19.0, 95% CI: 4.91 to 33.1; p = 0.014). Regarding diagnostic specificity, HDR-DP and C-DP yielded 46% and 75% (mean difference: 29.0, 95% CI: 13.4 to 44.6; p = 0.002).

CONCLUSIONS

HDR-DP statistically increased diagnostic sensitivity but not specificity. HDR-DP may be a screening tool for nonexpert ophthalmologists.