Interobserver agreement using Goldmann applanation tonometry and dynamic contour tonometry: comparing ophthalmologists, nurses and technicians

Kotecha, Aachal; Elkarmouty, Ahmed; Ajtony, Csilla; Barton, Keith

doi:10.1136/bjophthalmol-2015-307219

Cited by 14 publications

(12 citation statements)

References 18 publications

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“…It is also clear that nurse-led glaucoma clinics have been in existence for many years, for example Johnson et al 61 , including a role in glaucoma related laser procedures 62 ; however, the authors are unaware of empirical studies evaluating nursing decision making performance in glaucoma versus, for example, studies reporting on the taking of specific clinical measurements (e.g. tonometry 63 ). Similarly, in the UK there does not yet appear to be orthoptic specific evidence for performance in glaucoma care roles, albeit it can be legitimately argued that the overall HCP evidence base affords evidence well beyond "proof of concept", and as such the evidence available is likely to be applicable to any professional with appropriate training and accreditation and experience (a matter considered in more detail below).…”

Section: Care Pathways For Glaucoma Diagnosis and Monitoringmentioning

confidence: 99%

Care pathways for glaucoma detection and monitoring in the UK

Harper

Gunn

Spry

et al. 2019

Eye

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Glaucoma presents considerable challenges in providing clinically and cost-effective care pathways. While UK population screening is not seen as justifiable, arrangements for case finding have historically been considered relatively ineffective. Detection challenges include an undetected disease burden, whether from populations failing to access services or difficulties in delivering effective case-finding strategies, and a high false positive rate from referrals via traditional case finding pathways. The enhanced General Ophthalmic Service (GOS) in Scotland and locally commissioned glaucoma referral filtering services (GRFS) elsewhere have undoubtedly reduced false positive referrals, and there is emerging evidence of effectiveness of these pathways. At the same time, it is recognised that implementing GRFS does not intrinsically reduce the burden of undetected glaucoma and late presentation, and obvious challenges remain. In terms of diagnosis and monitoring, considerable growth in capacity remains essential, and non-medical health care professional (HCP) co-management and virtual clinics continue to be important solutions in offering requisite capacity. National guidelines, commissioning recommendations, and the Common Clinical Competency Framework have clarified requirements for such services, including recommendations on training and accreditation of HCPs. At the same time, the nature of consultant-delivered care and expectations on the glaucoma specialist's role has evolved alongside these developments. Despite progress in recent decades, given projected capacity requirements, further care pathways innovations appear mandated. While the timeline for implementing potential artificial intelligence innovations in streamlining care pathways is far from established, the glaucoma burden presents an expectation that such developments will need to be at the vanguard of future developments.

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Section: Care Pathways For Glaucoma Diagnosis and Monitoringmentioning

confidence: 99%

Care pathways for glaucoma detection and monitoring in the UK

Harper

Gunn

Spry

et al. 2019

Eye

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“…Prolonged exposition to this mechanical load leads to glaucoma and, eventually, to blindness. Since this degenerative process is generally asymptomatic, a number of devices have been developed to monitor the ocular pressure [1,2,3]. The first developed devices measured the IOP by direct contact with the cornea e.g.…”

Section: Introductionmentioning

confidence: 99%

Fluid–structure simulation of a general non-contact tonometry. A required complexity?

Ariza-Gracia

Calvo

et al. 2018

Computer Methods in Applied Mechanics and Engineering

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Understanding corneal biomechanics is important for applications regarding refractive surgery prediction outcomes and the study of pathologies affecting the cornea itself. In this regard, non-contact tonometry (NCT) is gaining interest as a non-invasive diagnostic tool in ophthalmology, and is becoming an alternative method to characterize corneal biomechanics : in :::: vivo. In general, identification of material parameters of the cornea from a NCT test relies on the inverse finite element method, for which an accurate and reliable modelization of the test is required. This study explores four different :::::::: modelling : strategies ranging from pure structural analysis up to a fluid-structure interaction model considering the air-cornea and humour-cornea interactions. The four approaches have been compared using clinical biomarkers commonly used in ophthalmology. Results from the simulations indicate the importance of considering the humors as fluids and the deformation of the cornea when determining the pressure applied by the air-jet during the test. Ignoring this two elements in the modeling lead to an overestimation of corneal displacement and therefore an overestimation of corneal stiffness when using the inverse finite element method.

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“…Repeated readings with contact tonometers are more reproducible than other automated measurements [ 29 ] and are the gold standard for IOP measurement. Kotecha et al [ 31 ] published studies showing that ophthalmologist doctors achieve better agreement in IOP measurements using contact tonometers and nursing technicians have better agreement with non-contact tonometers. Other variables can also interfere with IOP measures, including astigmatism, corneal thickness, biomechanics, accommodation, breathing, heart rate, and daily variation, resulting in a maximum clinically acceptable variation of ± 3.0 mmHg [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is known that continuous training and continuing education lead to establishment of standards for the quality of the assessments conducted by these professionals. In other countries, ophthalmology assistant professionals have helped in screening and follow-on ophthalmological diseases such as glaucoma and diabetic retinopathy in primary care [ 34 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy

et al. 2021

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Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25–0.25], 0.01 [95%-LoA: -0.86–0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1–0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4–4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82–0.91]; 0.97 [0.96–0.98]; 0.96 [0.95–0.97] and 0.88 [0.84–0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.

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Interobserver agreement using Goldmann applanation tonometry and dynamic contour tonometry: comparing ophthalmologists, nurses and technicians

Cited by 14 publications

References 18 publications

Care pathways for glaucoma detection and monitoring in the UK

Care pathways for glaucoma detection and monitoring in the UK

Fluid–structure simulation of a general non-contact tonometry. A required complexity?

Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy

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