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Anterior Chamber Angle Evaluation Using Gonioscopy

Consistency and Agreement between Optometrists and Ophthalmologists

Phu, Jack MPH, PhD, FAAO1,2*; Wang, Henrietta BOptom, BSc1,2; Khuu, Sieu K. BSc, PhD2; Zangerl, Barbara DVM, PhD1,2; Hennessy, Michael P. MBBS, MBiomedE1,3; Masselos, Katherine MBBS, MPH1,3; Kalloniatis, Michael MScOptom, PhD, FAAO1,2

doi: 10.1097/OPX.0000000000001432
ORIGINAL INVESTIGATION
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SIGNIFICANCE 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.

PURPOSE 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.

METHODS 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.

RESULTS 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.

CONCLUSIONS 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.

1Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia

2School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia

3Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia

*jphu@cfeh.com.au

Submitted: November 16, 2018

Accepted: July 21, 2019

Funding/Support: National Health and Medical Research Council (1033224; to MK). Guide Dogs NSW/ACT provides salary support for JP, HW, BZ, and MK, and funds the operating costs of Centre for Eye Health. Guide Dogs NSW/ACT had no role in the design or the conduct of this research.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions: Conceptualization: JP; Data Curation: JP, HW, MPH, KM; Formal Analysis: JP, HW, SKK, BZ; Funding Acquisition: MK; Investigation: JP; Methodology: JP, HW, MK; Resources: MK; Validation: JP; Visualization: JP; Writing – Original Draft: JP; Writing – Review & Editing: JP, HW, SKK, BZ, MPH, KM, MK.

© 2019 American Academy of Optometry