An evaluation of optometrists' ability to correctly identify and manage patients with ocular disease in the accident and emergency department of an eye hospital.
OBJECTIVE
To assess optometrists' ability to correctly identify and manage patients with different ocular conditions seen in the accident and emergency (A&E) department of an eye hospital.


METHODS
Randomly selected patients presenting to the A&E department were initially examined by one of two senior optometrists and a consultant ophthalmologist. A diagnosis and a management plan were made for each patient by the optometrist and by the consultant, who was blinded to the optometrists' plan. Agreement was assessed between optometrist and consultant ophthalmologist for primary and secondary diagnoses, management plan and whether patients could be seen by an optometrist only. Weighted kappa (kappa) statistics was used to assess the level of agreement in management between the two groups.


RESULTS
A total of 150 patients were assessed. The agreement in primary diagnosis and management outcome between the two groups were 89.3% (95% CI 83.2% to 93.8%) and 79.3% (95% CI 84.8% to 94.8%), respectively. A high level of agreement in management outcome was found (kappa = 0.82). No sight-threatening conditions were misdiagnosed by the optometrist.


CONCLUSIONS
There was good agreement in both the diagnosis and management plan between optometrists and the ophthalmologist. This study has shown that optometrists can potentially work safely in an A&E department of a busy eye hospital.
Hau
Scott
S
Department of Optometry, Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK. scott.hau@moorfields.nhs.uk
Ehrlich
Daniel
D
Binstead
Katy
K
Verma
Seema
S
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005128:Eye Diseases / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006302:Health Services Research; D006782:Hospitals, Special / Q000458:organization & administration; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000458:organization & administration; D009907:Optometry / Q000458:organization & administration* / Q000592:standards; D010347:Patient Care Planning; D011446:Prospective Studies; D012017:Referral and Consultation; D015203:Reproducibility of Results