Phu Jack, Wang Henrietta, Khuu Sieu K, Zangerl Barbara, Hennessy Michael P, Masselos Katherine, Kalloniatis Michael
Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.
School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia.
Optom Vis Sci. 2019 Oct;96(10):751-760. doi: 10.1097/OPX.0000000000001432.
In our intermediate-tier glaucoma care clinic, we demonstrate fair to moderate agreement in gonioscopy examination between optometrists and ophthalmologists, but excellent agreement when considering open versus closed angles. We highlight the need for increased consistency in the evaluation and recording of angle status using gonioscopy.
The consistency of gonioscopy results obtained by different clinicians is not known but is important in moving toward practice modalities such as telemedicine and collaborative care clinics. The purpose of this study was to evaluate the description and concordance of gonioscopy results among different practitioners.
The medical records of 101 patients seen within a collaborative care glaucoma clinic who had undergone gonioscopic assessment by two clinicians (one optometrist and either one general ophthalmologist [n = 50] or one glaucoma specialist [n = 51]) were reviewed. The gonioscopy records were evaluated for their descriptions of deepest structure seen, trabecular pigmentation, iris configuration, and other features. These were compared between clinicians (optometrist vs. ophthalmologist) and against the final diagnosis.
Overall, 51.9 and 59.8% of angles were graded identically in terms of deepest visible structure when comparing between optometrist versus general ophthalmologist and optometrist versus glaucoma specialist, respectively. The concordance increased when considering ±1 of the grade (67.4 and 78.5%, respectively), and agreement with the final diagnosis was high (>90%). Variations in angle grading other than naming structures were observed (2.0, 30, and 3.9% for optometrist, general ophthalmologist, and glaucoma specialist, respectively). Most of the time, trabecular pigmentation or iris configuration was not described.
Fair to moderate concordance in gonioscopy was achieved between optometrists and ophthalmologists in a collaborative care clinic in which there is consistent feedback and clinical review. To move toward unified medical records and a telemedicine model, improved consistency of record keeping and angle description is required.
在我们的中级青光眼护理诊所中，我们发现验光师和眼科医生在房角镜检查中的一致性为中等水平，但在区分开角和闭角方面一致性极佳。我们强调在使用房角镜评估和记录房角状态时需要提高一致性。
不同临床医生获得的房角镜检查结果的一致性尚不清楚，但这对于向远程医疗和协作护理诊所等实践模式发展很重要。本研究的目的是评估不同从业者之间房角镜检查结果的描述及一致性。
回顾了在协作护理青光眼诊所就诊的101例患者的病历，这些患者均由两名临床医生（一名验光师和一名普通眼科医生[n = 50]或一名青光眼专科医生[n = 51]）进行了房角镜评估。对房角镜记录中所见最深结构、小梁色素沉着、虹膜形态及其他特征的描述进行评估。将这些结果在临床医生（验光师与眼科医生）之间进行比较，并与最终诊断结果进行对比。
总体而言，在比较验光师与普通眼科医生以及验光师与青光眼专科医生时，分别有51.9%和59.8%的房角在最深可见结构方面分级相同。若考虑分级相差±1，则一致性有所提高（分别为67.4%和78.5%），且与最终诊断的一致性较高（＞90%）。观察到除结构命名外的房角分级存在差异（验光师、普通眼科医生和青光眼专科医生分别为2.0%、30%和3.9%）。大多数情况下，未对小梁色素沉着或虹膜形态进行描述。
在有持续反馈和临床审查的协作护理诊所中，验光师和眼科医生在房角镜检查方面达成了中等水平的一致性。为了实现统一的病历记录和远程医疗模式，需要提高记录保存和房角描述的一致性。
