Paudel Prakash, Cronjé Sonja, O'Connor Patricia M, Rao Gullapalli N, Holden Brien A
a Brien Holden Vision Institute , Sydney , New South Wales , Australia .
b Vision Cooperative Research Centre , Sydney , New South Wales , Australia .
Ophthalmic Epidemiol. 2015;22(6):409-16. doi: 10.3109/09286586.2015.1082605.
To assess clinical competency of 1-year trained vision technicians (VTs) in detecting and referring causes of visual impairment in India.
Eye examination results and management plans for 328 patients examined by 24 VTs in 24 vision centers of LV Prasad Eye Institute in Andhra Pradesh were compared with those of a standard optometrist who examined the same patients. Eye examinations included retinoscopy and subjective refraction, slit lamp examination, applanation tonometry and undilated direct ophthalmoscopy. Data were analyzed for level of concordance in retinoscopy, spectacle prescription, disease detection and referral.
VTs demonstrated moderate to good levels of agreement in refraction, disease detection and referral. Sensitivity and specificity for ocular pathology identification were 77.4% (95% confidence interval, CI, 69.4-84.2%) and 86.6% (95% CI 81.1-91.1%), respectively. The highest sensitivity was demonstrated in detecting significant cataract (91.5%) and refractive error (83.0%). VT spectacle prescriptions were accurate 76% of the time for mean spherical equivalent and 65% of the time for astigmatism. VT sensitivity in detecting posterior segment abnormalities was low (18.5%) resulting in failure to detect retinal conditions such as diabetic retinopathy and maculopathy. Despite lack of recognition of the specific pathology, referral decisions were correct in 78.4% of cases.
VTs in India competently detect and manage or refer the two most common causes of visual impairment; uncorrected refractive error and cataract. Over two-thirds of patients received accurate and appropriate services from VTs, suggesting that they are a useful and competent cadre for rural and remote eye care.
评估在印度经过1年培训的视力检测技术员（VTs）在检测和转诊视力损害原因方面的临床能力。
将安得拉邦LV普拉萨德眼科研究所24个视力检测中心的24名VTs对328例患者进行的眼部检查结果及管理计划，与对相同患者进行检查的标准验光师的结果进行比较。眼部检查包括视网膜检影和主观验光、裂隙灯检查、压平眼压测量和不散瞳直接检眼镜检查。分析视网膜检影、眼镜处方、疾病检测和转诊方面的一致性水平数据。
VTs在验光、疾病检测和转诊方面表现出中等至良好的一致性水平。眼部病理学识别的敏感性和特异性分别为77.4%（95%置信区间，CI，69.4 - 84.2%）和86.6%（95%CI 81.1 - 91.1%）。在检测明显白内障（91.5%）和屈光不正（83.0%）方面表现出最高敏感性。VTs的眼镜处方在平均球镜等效度方面76%的时间准确，在散光方面65%的时间准确。VTs检测后段异常的敏感性较低（18.5%），导致未能检测到糖尿病视网膜病变和黄斑病变等视网膜疾病。尽管未识别出具体病理学情况，但78.4%的病例转诊决策正确。
印度的VTs能够胜任地检测和管理或转诊两种最常见的视力损害原因；未矫正的屈光不正和白内障。超过三分之二的患者从VTs那里获得了准确和适当的服务，这表明他们是农村和偏远地区眼保健的一支有用且称职的队伍。
