title: Evaluation of the effectiveness of ophthalmic assistants as screeners for glaucoma in North India.
abstract: OBJECTIVE
  To assess whether ophthalmic assistants are effective in screening people for glaucoma in India.
  
  
  METHODS
  The study subjects were examined by both trained ophthalmic assistants and an ophthalmologist in both hospital and community settings. Specific tests for the diagnosis of glaucoma suspects included visual field examination using frequency doubling technology perimetry, intraocular pressure measurement (Tonopen), A-scan central anterior chamber depth measurement and dilated optic disc examination. The findings recorded by the ophthalmic assistants were masked to the ophthalmologist to avoid measurement bias.
  
  
  RESULTS
  In the hospital setting, there was a substantial level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (89.29%, k=0.7, 95% confidence interval (CI)=0.54-0.86). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was high for sensitivity (95.2%, 95% CI=91.4-97.7%) but lower for specificity at 71.4% (95% CI=60.0-78.7%).In the community setting, there was a moderate level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (78.23%, k=0.50, 95% CI=0.37-0.64). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was moderate for sensitivity (82.9, 95% CI=69.7-91.5%) but lower for specificity at 76.8% (95% CI=72.7-79.5%).
  
  
  CONCLUSIONS
  Ophthalmic assistants can be used for opportunistic case detection of glaucoma suspects in the community. Structured training of the ophthalmic assistants together with enhanced clinical experience would improve their performance in detecting glaucoma suspects in the community.
authors: Department of Cataract and Glaucoma Services, Venu Eye Institute and Research Centre, Sheikh Sarai Industrial Area, New Delhi, India. drsubodhsinha@gmail.com
authors: S K
authors: SK
authors: Sinha
authors: N
authors: N
authors: Astbury
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D016001:Confidence Intervals; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007194:India / Q000453:epidemiology; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis; D009881:Ophthalmic Assistants / Q000193:education / Q000592:standards / Q000639:trends; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014065:Tonometry, Ocular; D058609:Visual Field Tests / Q000592:standards*