title: Selection considerations when using a 'standard optometrist' to evaluate clinical performance of other eye-care personnel.
abstract: BACKGROUND
  Selection of a standard professional is crucial for assessing the clinical performance of other eye-care personnel. This paper describes the selection considerations and the clinical competency assessment of two optometrists required to select a 'standard optometrist' (SO) for evaluating the clinical performance of vision technicians in India.
  
  
  METHODS
  Two optometrists were short-listed from 21 optometrists who responded to an advertisement to be selected as a SO for the assessment of the performance of 24 vision technicians in rural vision centres. Each candidate optometrist performed a routine eye examination on 40 randomly selected, newly registered subjects in a tertiary hospital clinic. Their non-cycloplegic retinoscopic findings were compared with those of an experienced optometrist, while disease diagnoses were compared with the findings of an ophthalmologist.
  
  
  RESULTS
  A comparison of retinoscopic findings showed that optometrist A produced retinoscopic values within ±0.50 D agreement for the spherical equivalent (SE) 100 per cent of the time, while optometrist B obtained agreement 91.3 per cent of the time. Similarly, optometrist A's limits of agreement (SE = -0.63 to +0.45 D) and reproducibility limits (SE = 0.78 D) were better than those of optometrist B (SE = -0.98 to +0.70 D and SE =1.18 D, respectively). Optometrist A demonstrated 89.2 per cent sensitivity in detecting ocular pathology compared to 76.3 per cent by optometrist B.
  
  
  CONCLUSIONS
  Optometrist A achieved consistent and reproducible retinoscopic findings as well as higher sensitivity in detecting ocular pathology and was selected as the SO for a study to assess the clinical performance of one-year trained vision technicians. The concept of a SO calibrated against an ophthalmologist for disease detection and diagnosis and an experienced optometrist for retinoscopy is a useful approach for the evaluation of eye-care personnel.
authors.affiliation: Brien Holden Vision Institute, Sydney, Australia; School of Optometry and Vision Science, University of New South Wales, Kensington, Australia; Vision Cooperative Research Centre, Sydney, Australia. p.paudel@brienholdenvision.org.
authors.forename: Prakash
authors.initials: P
authors.lastname: Paudel
authors.forename: Sonja
authors.initials: S
authors.lastname: Cronjé
authors.forename: Patricia M
authors.initials: PM
authors.lastname: O'Connor
authors.forename: Gullapalli N
authors.initials: GN
authors.lastname: Rao
authors.forename: Brien A
authors.initials: BA
authors.lastname: Holden
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005128:Eye Diseases / Q000175:diagnosis*; D005260:Female; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008297:Male; D009907:Optometry; D015203:Reproducibility of Results; D042262:Retinoscopy / Q000379:methods*; D000078329:Workforce
keywords: clinical performance; disease detection; retinoscopy; standard optometrist; vision technician