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A Randomized Trial to Increase the Assessment Accuracy of Glaucoma and Optic Disc Characteristics by Orthoptists

Scheetz, Jane PhD; Koklanis, Konstandina PhD; McGuinness, Myra PhD; Long, Maureen PhD; Morris, Meg E. PhD

Journal of Continuing Education in the Health Professions: Summer 2019 - Volume 39 - Issue 3 - p 161–167
doi: 10.1097/CEH.0000000000000258
Original Research

Introduction: The aim of this study was to determine the accuracy of orthoptists when examining the optic disc for signs of glaucoma, and to explore the impact of targeted clinical education on accuracy.

Methods: In this randomized controlled trial, 42 monoscopic color optic disc images were presented to 46 orthoptists who assessed the likelihood of glaucoma as well as optic disc size, shape, tilting, vertical cup-to-disc ratio, cup shape, depth, presence of hemorrhage, peripapillary atrophy, and retinal nerve fiber layer. The level of agreement with specialist ophthalmologists was assessed. Participants were then randomly assigned to an experimental group (targeted postgraduate education on optic disc assessment) or to no intervention. The educational program was designed to increase knowledge of the characteristic features associated with glaucomatous optic neuropathy. All participants re-examined the included optic disc images after a period of 6 to 8 weeks. The primary outcome measure was a change in agreement between attempts.

Results: The education group showed significant improvements between attempts for identifying hemorrhages (P = .013), retinal nerve fiber layer defects (0.035), disc size (P = .001), peripapillary atrophy (P = .030), and glaucoma likelihood (P = .023). The control group did not show any statistically significant improvement. The intervention group showed significantly more improvement when identifying hemorrhages (P = .013), disc size (P = .001), disc shape (P = .033), and cup shape (P = .020) compared with the control group.

Discussion: Orthoptists who received additional postgraduate online education based on principles of adult learning were more accurate at assessing the optic disc for glaucoma. These results highlight the value of continuing education to optimize clinical practice in allied health professionals.

Dr. Scheetz: Post-doctoral Research Fellow,Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia. Dr. Koklanis: Head of Discipline, Orthoptics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia. Dr. McGuinness: Biostatistician,Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia. Dr. Long: Senior Lecturer, School of Allied Health, Human Services and Sport, School of Allied Health, La Trobe University, Melbourne, Australia. Professor Morris: Professor of Clinical and Rehabilitation Practice, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia, and North Eastern Rehabilitation Center, Healthscope, Ivanhoe, Australia.

Correspondence: Jane Scheetz, PhD, Center for Eye Research Australia, Level 7, 32 Gisborne Street, East Melbourne, VIC 3002, Australia; e-mail:

Disclosures: The authors declare no conflict of interest.

Ethics approval was sought and granted from the La Trobe University Faculty of Health Sciences Human Ethics Committee (FHEC14/235). Written informed consent was obtained from all participants in accordance with the Declaration of Helsinki.

Received February 19, 2019

Accepted May 10, 2019

© 2019 Lippincott Williams & Wilkins, Inc.
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