title: Clinical Competency of 1-Year Trained Vision Technicians in Andhra Pradesh, India.
abstract: OBJECTIVE
  To assess clinical competency of 1-year trained vision technicians (VTs) in detecting and referring causes of visual impairment in India.
  
  
  METHODS
  Eye examination results and management plans for 328 patients examined by 24 VTs in 24 vision centers of LV Prasad Eye Institute in Andhra Pradesh were compared with those of a standard optometrist who examined the same patients. Eye examinations included retinoscopy and subjective refraction, slit lamp examination, applanation tonometry and undilated direct ophthalmoscopy. Data were analyzed for level of concordance in retinoscopy, spectacle prescription, disease detection and referral.
  
  
  RESULTS
  VTs demonstrated moderate to good levels of agreement in refraction, disease detection and referral. Sensitivity and specificity for ocular pathology identification were 77.4% (95% confidence interval, CI, 69.4-84.2%) and 86.6% (95% CI 81.1-91.1%), respectively. The highest sensitivity was demonstrated in detecting significant cataract (91.5%) and refractive error (83.0%). VT spectacle prescriptions were accurate 76% of the time for mean spherical equivalent and 65% of the time for astigmatism. VT sensitivity in detecting posterior segment abnormalities was low (18.5%) resulting in failure to detect retinal conditions such as diabetic retinopathy and maculopathy. Despite lack of recognition of the specific pathology, referral decisions were correct in 78.4% of cases.
  
  
  CONCLUSIONS
  VTs in India competently detect and manage or refer the two most common causes of visual impairment; uncorrected refractive error and cataract. Over two-thirds of patients received accurate and appropriate services from VTs, suggesting that they are a useful and competent cadre for rural and remote eye care.
authors.affiliation: a Brien Holden Vision Institute , Sydney , New South Wales , Australia .|b Vision Cooperative Research Centre , Sydney , New South Wales , Australia .|c School of Optometry and Vision Science, University of New South Wales , Sydney , New South Wales , Australia .
authors.forename: Prakash
authors.initials: P
authors.lastname: Paudel
authors.affiliation: a Brien Holden Vision Institute , Sydney , New South Wales , Australia .|b Vision Cooperative Research Centre , Sydney , New South Wales , Australia .|c School of Optometry and Vision Science, University of New South Wales , Sydney , New South Wales , Australia .
authors.forename: Sonja
authors.initials: S
authors.lastname: Cronjé
authors.affiliation: b Vision Cooperative Research Centre , Sydney , New South Wales , Australia .|d School of Social Sciences, University of Western Sydney , Sydney , New South Wales , Australia , and.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: O'Connor
authors.affiliation: b Vision Cooperative Research Centre , Sydney , New South Wales , Australia .|e LV Prasad Eye Institute , Hyderabad , India.
authors.forename: Gullapalli N
authors.initials: GN
authors.lastname: Rao
authors.affiliation: a Brien Holden Vision Institute , Sydney , New South Wales , Australia .|b Vision Cooperative Research Centre , Sydney , New South Wales , Australia .|c School of Optometry and Vision Science, University of New South Wales , Sydney , New South Wales , Australia .
authors.forename: Brien A
authors.initials: BA
authors.lastname: Holden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D004521:Educational Measurement; D005139:Eyeglasses / Q000592:standards; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009881:Ophthalmic Assistants / Q000193:education* / Q000592:standards*; D009887:Ophthalmoscopy / Q000592:standards; D011237:Predictive Value of Tests; D055656:Prescriptions / Q000592:standards; D012029:Refraction, Ocular; D015203:Reproducibility of Results; D042262:Retinoscopy / Q000592:standards; D019035:Rural Health Services; D012680:Sensitivity and Specificity; D066167:Slit Lamp / Q000592:standards; D014065:Tonometry, Ocular / Q000592:standards; D014787:Vision Tests / Q000592:standards*; D019987:Persons with Visual Disabilities / Q000534:rehabilitation
keywords: Clinical competency; disease detection; retinoscopy; vision technician; visual impairment