Evaluation of the effectiveness of ophthalmic assistants as screeners for glaucoma in North India

Abstract

Aim To assess whether ophthalmic assistants are effective in screening people for glaucoma in India. Methodology The study subjects were examined by both trained ophthalmic assistants and an ophthalmologist in both hospital and community settings. Specific tests for the diagnosis of glaucoma suspects included visual field examination using frequency doubling technology perimetry, intraocular pressure measurement (Tonopen), A-scan central anterior chamber depth measurement and dilated optic disc examination. The findings recorded by the ophthalmic assistants were masked to the ophthalmologist to avoid measurement bias. Results In the hospital setting, there was a substantial level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (89.29%, k ¼ 0.7, 95% confidence interval (CI) ¼ 0.54-0.86). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was high for sensitivity (95.2%, 95% CI ¼ 91.4-97.7%) but lower for specificity at 71.4% (95% CI ¼ 60.0-78.7%). In the community setting, there was a moderate level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (78.23%, k ¼ 0.50, 95% CI ¼ 0.37-0.64). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was moderate for sensitivity (82.9, 95% CI ¼ 69.7-91.5%) but lower for specificity at 76.8% (95% CI ¼ 72.7-79.5%). Conclusion Ophthalmic assistants can be used for opportunistic case detection of glaucoma suspects in the community. Structured training of the ophthalmic assistants together with enhanced clinical experience would improve their performance in detecting glaucoma suspects in the community.

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

“…Table 2 illustrates the characteristics of the 32 articles that underwent data extraction for this review. Fifteen used optic disc photographs as the measurement tool (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), five used visual fields (32)(33)(34)(35)(36), two ophthalmoscopy (37,38), six compared findings from a clinical examination (39)(40)(41)(42)(43)(44) and the remaining four used a combination of either optic disc photographs, visual fields, HRT or scanning laser polarimetry (45,46). The study setting was not specified in a large proportion of articles.…”

“…Power calculations and effect sizes were absent more often than not making it difficult to make any inferences. In addition, several studies included disproportionate numbers of clinicians; at times only utilising one expert to compare multiple health professionals (20,30,38,39,43,44). For example, Theodossiades and Murdoch (38) included eight optometrists and one ophthalmologist.…”

“…The characteristics of included subjects varied. Very few studies gave a specific classification for their diagnosis of glaucoma, with 17 studies noting that subjects had glaucoma but gave no classification (18,20,22,25,32,35,36,(38)(39)(40)(41)(42)(43)(44)(45)(46). Seven studies included glaucoma subjects who had glaucomatous field loss (17,18,21,28,29,35,36) one study classified their subjects as having glaucoma with early to moderate disc damage (19) and three gave the classification of OAG (26,32,33).…”

Towards better management of glaucoma in India

“…[ 21 ] Currently, the community-based glaucoma detection by optometrists is not effective but targeted training can improve the outcomes. [ 22 , 23 ] Artificial intelligence-based algorithms and teleophthalmology may be a boon in this direction. These task-shifting approaches are likely to be relevant and highly cost-effective in countries such as India, which have a large proportion of the aging population and limited resources.…”

Efficacy and safety of topical BAK-free travoprost 0.004% versus BAK-preserved travoprost 0.004% in the treatment of primary open angle glaucoma: a comparative study at a tertiary care hospital

“…In India, glaucoma is responsible for approximately 5.8% of blindness. 3 The central role of IOP reduction in decreasing the risk of development or progression of POAG has been borne out in several landmark randomized controlled trials and thus drugs that reduce IOP have the potential to prevent or delay optic nerve damage and preserve vision.…”