The community approach

A UK study comparing the monitoring abilities of trained optometrists and ophthalmologists supports recent calls for more care in the community.

Professor Usha Chakravarthy, of The Queen’s University, Belfast, and Barney Reeves, of Bristol University, found that – after an education and approval process – optometrists with no prior experience were just as successful at identifying patients with returning wet age-related macular degeneration (AMD).

Professor Chakravarthy told OT that 48 optometrists took a series of webinars. Following this, both optometrists and ophthalmologists had to pass a formal test before they were eligible for the study, which was published in the online journal BMJOpen.

She added: “By these means we ensured that all participants had sufficient knowledge of retinal anatomy, structure and how disease affects these tissues, thus allowing them to interpret the tomographic scans. Therefore, we would have been surprised if there had been a large difference between the groups of participants. The results were consistent with this expectation.”

The 48 practitioners and their ophthalmic counterparts were offered vignettes – comprising clinical information, before-and-after retinal images and best-corrected visual acuity measurements – from anonymous, but real, patients.

Professor Reeves explained that, while overall the practitioners classified the vignettes just as accurately, optometrists tended to be more cautious than the doctors, and more readily said that a patient’s wet AMD had returned.

He emphasised that: “[This] would be consistent with their obligations under the General Ophthalmic Services contract to refer any suspected pathology.

“The finding may also reflect the fact that optometrists had more difficulty in interpreting the diversity of appearance of quiescent lesions – that is eyes with an abnormal appearance but not needing treatment, which are normally managed in the hospital eye service,” Professor Reeves said.

Professor Chakravarthy noted that enhancing shared care services is an important way to reduce the workload in hospitals.

“Our research has highlighted that routine monitoring of [wet] AMD can effectively take place in the community, which not only frees up hospital appointments, but is often more convenient for patients,” she said.

However, the professor also cautioned that: “Any proposal to introduce shared care must include validation of the performance of participating community optometrists through appropriate testing and training.

“Appropriate tests would have to be developed and methods put in place to monitor adherence to standards during implementation,” she advised.

This research was funded by the National Institute for Health Research.

Image credit: Daniel Barquet