title: Accuracy of vision technicians in screening ocular pathology at rural vision centres of southern India.
abstract: BACKGROUND
  There is paucity of data on the inter-observer agreement and diagnostic accuracy between a primary-care technician (vision technician) and an ophthalmologist. Hence, the current study was conducted to assess the accuracy of vision technicians, to screen potentially sight-threatening ocular conditions at rural vision centres of southern India and their agreement with an ophthalmologist.
  
  
  METHODS
  In July to August 2010, patients presenting to seven vision centres in Adilabad district (Andhra Pradesh) were selected and screened in a masked manner by seven vision technicians followed by an examination by a consultant ophthalmologist. Agreement was assessed between vision technicians and the ophthalmologist for screening of potential sight-threatening ocular conditions and decisions for referral. The ophthalmologist's findings were considered as the reference standard.
  
  
  RESULTS
  Two hundred and seventy-nine patients were enrolled at seven vision centres with a mean age of 32.9 ± 21.8 years. Agreement for screening of ocular pathology was 0.82 (95 per cent CI, 0.8-0.83). There was excellent agreement for cataract (0.97; 95 per cent CI, 0.93-1), refractive error (0.98; 95 per cent CI, 0.96-1), corneal pathology (1.0; 95 per cent CI, 1.0-1.0) and other anterior segment pathology (0.95; 95 per cent CI, 0.9-1); the agreement was moderate to fair for detection of glaucoma suspects (0.43; 95 per cent CI, 0.28-0.60) and retinal pathology (0.39; 95 per cent CI, 0.14-0.63). Sensitivity for screening of anterior segment pathology was 94.6-100 per cent. There was a fair to moderate sensitivity for glaucoma suspect; 35.6 per cent (95 per cent CI, 21.9-51.2) and retinal pathology 26.3 per cent (95 per cent CI, 9.2-51.2). Specificity for screening of ocular pathology was 98.2 to 100 per cent. The kappa (κ) agreement for referral for any pathology was 0.82 (0.8-0.83) CONCLUSION: As there is good agreement between the vision technicians and the ophthalmologist for screening and referral of anterior segment pathology but moderate to fair for glaucoma suspects and retinal pathology, vision technicians would be a good resource at the primary level to screen for anterior segment pathology; however, they may need further training to detect posterior segment pathology.
authors.affiliation: A C Subba Reddy Government Medical College, Nellore, Andhra Pradesh, India.
authors.forename: Vasantha
authors.initials: V
authors.lastname: Suram
authors.affiliation: Allen Foster Community Eye Health Research Center, Gullapalli Pratibha Rao-International Center for Advancement of Rural Eye care, LV Prasad Eye Institute, Hyderabad, India.|Brien Holden Eye Research Centre, LV Prasad Eye Institute, Banjara Hills, Hyderabad, India.|V S T Center for Glaucoma Services, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.|Vision Cooperative Research Centre, Sydney, Australia.
authors.forename: Uday Kumar
authors.initials: UK
authors.lastname: Addepalli
authors.affiliation: Health Promotion, Public Health Foundation of India, New Delhi, India.
authors.forename: Sannapaneni
authors.initials: S
authors.lastname: Krishnaiah
authors.affiliation: Brien Holden Vision Institute, Sydney, Australia.|Health Promotion Services, Population Health, South Western Sydney Local Health District, Sydney, Australia.
authors.forename: Vilas
authors.initials: V
authors.lastname: Kovai
authors.affiliation: Allen Foster Community Eye Health Research Center, Gullapalli Pratibha Rao-International Center for Advancement of Rural Eye care, LV Prasad Eye Institute, Hyderabad, India. rohit@lvpei.org.|Brien Holden Eye Research Centre, LV Prasad Eye Institute, Banjara Hills, Hyderabad, India. rohit@lvpei.org.|School of Optometry and Vision Science, University of New South Wales, Sydney, Australia. rohit@lvpei.org.
authors.forename: Rohit C
authors.initials: RC
authors.lastname: Khanna
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002983:Clinical Competence / Q000592:standards*; D005128:Eye Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009881:Ophthalmic Assistants / Q000592:standards*; D009885:Ophthalmology / Q000592:standards; D012017:Referral and Consultation; D015203:Reproducibility of Results; D019035:Rural Health Services / Q000706:statistics & numerical data; D012424:Rural Population; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000592:standards*; D055815:Young Adult
keywords: ophthalmologist; referral; screening; vision centre; vision technician