title: Influence of education and diagnostic modes on glaucoma assessment by optometrists.
abstract: OBJECTIVE
  To evaluate the influence of different clinical examination techniques, including optic nerve head (ONH) photography, visual field tests, and adjunct imaging on the diagnosis of glaucoma by Australian and New Zealand optometrists. The effect of a short-term, didactic teaching module on these is also explored.
  
  
  METHODS
  Clinical data of 30 patients previously seen at the Centre for Eye Health was collected and compiled into glaucoma diagnostic assessment modules. Each of six modules contained different combinations of clinical examination results and required a classification of the cases as normal, suspicious or glaucoma. A cohort of 54 Australian and New Zealand optometrists were recruited for the study and allocated into two cohorts. The intervention group completed a glaucoma training course prior to the assessment while the control group completed the assessment without additional training. Diagnostic accuracy was compared between modules and optometrist groups.
  
  
  RESULTS
  High false negative rates were observed with ONH photography, which were drastically reduced with the addition of visual field, albeit at the cost of increased false positive rates. Addition of adjunct imaging techniques partially compensated for the increase in the false positive rate from the visual field, but had limited effect on false negative rate. Educational intervention resulted in larger improvement in the diagnostic ability when multiple imaging modalities were provided.
  
  
  CONCLUSIONS
  The study highlighted the importance of combining both structural and functional assessments in glaucoma. Current imaging technology demonstrated limited usefulness for event diagnosis due to the persistent difficulties of defining structural and functional loss in glaucoma, thus highlighting the need for new glaucoma assessment techniques. Short-term didactic teaching programs may only result in limited improvement of glaucoma diagnostic ability in optometrists, and hence, it may need to be combined with long-term and/or non-didactic training components to obtain a greater effect.
authors.affiliation: Centre for Eye Health, UNSW Australia, Sydney, Australia.|School of Optometry and Vision Science, UNSW Australia, Sydney, Australia.
authors.forename: Nayuta
authors.initials: N
authors.lastname: Yoshioka
authors.affiliation: Centre for Eye Health, UNSW Australia, Sydney, Australia.|School of Optometry and Vision Science, UNSW Australia, Sydney, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wong
authors.affiliation: Centre for Eye Health, UNSW Australia, Sydney, Australia.|School of Optometry and Vision Science, UNSW Australia, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Kalloniatis
authors.affiliation: Centre for Eye Health, UNSW Australia, Sydney, Australia.|School of Optometry and Vision Science, UNSW Australia, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Yapp
authors.affiliation: Centre for Eye Health, UNSW Australia, Sydney, Australia.|Ophthalmology, Prince of Wales Hospital, Randwick, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hennessy
authors.affiliation: Ophthalmology, Prince of Wales Hospital, Randwick, Australia.
authors.forename: Ashish
authors.initials: A
authors.lastname: Agar
authors.affiliation: Centre for Vision Research, Westmead Millenium Institute, University of Sydney, Sydney, Australia.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Healey
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayen
authors.affiliation: Centre for Eye Health, UNSW Australia, Sydney, Australia.|School of Optometry and Vision Science, UNSW Australia, Sydney, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zangerl
mesh_terms: D000368:Aged; D001315:Australia; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D009520:New Zealand; D009898:Optic Disk; D009907:Optometry / Q000193:education* / Q000379:methods*; D010781:Photography; D041623:Tomography, Optical Coherence / Q000379:methods; D058609:Visual Field Tests / Q000379:methods; D014794:Visual Fields / Q000502:physiology
keywords: accuracy; diagnosis; glaucoma; optic nerve head; optometrist; visual field