Spry P G, Spencer I C, Sparrow J M, Peters T J, Brookes S T, Gray S, Baker I, Furber J E, Easty D L
Department of Ophthalmology, University of Bristol, Bristol.
Br J Ophthalmol. 1999 Jun;83(6):707-12. doi: 10.1136/bjo.83.6.707.
BACKGROUND/AIMS: Primary open angle glaucoma patients and glaucoma suspects make up a considerable proportion of outpatient ophthalmological attendances and require lifelong review. Community optometrists can be suitably trained for assessment of glaucoma. This randomised controlled trial aims to assess the ability of community optometrists in the monitoring of this group of patients.
Measures of cup to disc ratio, visual field score, and intraocular pressure were taken by community optometrists, the hospital eye service and a research clinic reference "gold" standard in 405 stable glaucoma patients and ocular hypertensives. Agreement between and within the three centres was assessed using mean differences and intraclass correlation coefficients. Tolerance limits for a change in status at the level of individual pairs of measurements were also calculated.
Compared with a research clinic reference standard, measurements made by community optometrists and those made in the routine hospital eye service were similar. Mean measurement differences and variability were similar across all three groups compared for each of the test variables (IOP, cup to disc ratio, and visual field). Overall, the visual field was found to be the most reliable measurement and the cup to disc ratio the least.
Trained community optometrists are able to make reliable measurements of the factors important in the assessment of glaucoma patients and glaucoma suspects. This clinical ability should allow those optometrists with appropriate training to play a role in the monitoring of suitable patients.
背景/目的：原发性开角型青光眼患者和青光眼疑似患者占眼科门诊就诊人数的相当比例，需要终身随访。社区验光师可以接受适当培训以评估青光眼。这项随机对照试验旨在评估社区验光师监测这类患者的能力。
社区验光师、医院眼科服务部门以及一家研究诊所参考“金标准”，对405例稳定的青光眼患者和高眼压症患者进行了杯盘比、视野评分和眼压测量。使用均值差异和组内相关系数评估三个中心之间以及中心内部的一致性。还计算了个体测量对水平上状态变化的公差限度。
与研究诊所参考标准相比，社区验光师的测量结果与常规医院眼科服务部门的测量结果相似。对于每个测试变量（眼压、杯盘比和视野），所有三组的平均测量差异和变异性相似。总体而言，视野被认为是最可靠的测量指标，杯盘比是最不可靠的。
经过培训的社区验光师能够对青光眼患者和青光眼疑似患者评估中重要的因素进行可靠测量。这种临床能力应使那些经过适当培训的验光师能够在监测合适患者方面发挥作用。
