Yoshioka Nayuta, Wong Elizabeth, Kalloniatis Michael, Yapp Michael, Hennessy Michael P, Agar Ashish, Healey Paul R, Hayen Andrew, Zangerl Barbara
Centre for Eye Health, UNSW Australia, Sydney, Australia.
School of Optometry and Vision Science, UNSW Australia, Sydney, Australia.
Ophthalmic Physiol Opt. 2015 Nov;35(6):682-98. doi: 10.1111/opo.12247. Epub 2015 Oct 2.
To evaluate the influence of different clinical examination techniques, including optic nerve head (ONH) photography, visual field tests, and adjunct imaging on the diagnosis of glaucoma by Australian and New Zealand optometrists. The effect of a short-term, didactic teaching module on these is also explored.
Clinical data of 30 patients previously seen at the Centre for Eye Health was collected and compiled into glaucoma diagnostic assessment modules. Each of six modules contained different combinations of clinical examination results and required a classification of the cases as normal, suspicious or glaucoma. A cohort of 54 Australian and New Zealand optometrists were recruited for the study and allocated into two cohorts. The intervention group completed a glaucoma training course prior to the assessment while the control group completed the assessment without additional training. Diagnostic accuracy was compared between modules and optometrist groups.
High false negative rates were observed with ONH photography, which were drastically reduced with the addition of visual field, albeit at the cost of increased false positive rates. Addition of adjunct imaging techniques partially compensated for the increase in the false positive rate from the visual field, but had limited effect on false negative rate. Educational intervention resulted in larger improvement in the diagnostic ability when multiple imaging modalities were provided.
The study highlighted the importance of combining both structural and functional assessments in glaucoma. Current imaging technology demonstrated limited usefulness for event diagnosis due to the persistent difficulties of defining structural and functional loss in glaucoma, thus highlighting the need for new glaucoma assessment techniques. Short-term didactic teaching programs may only result in limited improvement of glaucoma diagnostic ability in optometrists, and hence, it may need to be combined with long-term and/or non-didactic training components to obtain a greater effect.
评估不同临床检查技术，包括视神经乳头（ONH）摄影、视野测试和辅助成像，对澳大利亚和新西兰验光师诊断青光眼的影响。还探讨了短期教学模块对这些技术的影响。
收集了30名先前在眼健康中心就诊的患者的临床数据，并将其编入青光眼诊断评估模块。六个模块中的每一个都包含不同的临床检查结果组合，并要求将病例分类为正常、可疑或青光眼。招募了54名澳大利亚和新西兰验光师参与该研究，并将其分为两个队列。干预组在评估前完成了青光眼培训课程，而对照组在没有额外培训的情况下完成了评估。比较了各模块和验光师组之间的诊断准确性。
ONH摄影观察到较高的假阴性率，增加视野检查后假阴性率大幅降低，尽管代价是假阳性率增加。添加辅助成像技术部分补偿了视野检查导致的假阳性率增加，但对假阴性率影响有限。当提供多种成像方式时，教育干预导致诊断能力有更大提高。
该研究强调了青光眼结构和功能评估相结合的重要性。由于青光眼结构和功能丧失的定义一直存在困难，目前的成像技术在事件诊断中的作用有限，因此凸显了新的青光眼评估技术的必要性。短期教学计划可能只会使验光师的青光眼诊断能力有有限提高，因此，可能需要将其与长期和/或非教学培训内容相结合以获得更大效果。
