Ophthalmologists and optometrists working in a team practice agreed on a mutual diagnosis of glaucoma progression slightly more than half the time when they were masked to their colleagues’ diagnosis, a recent study reports.
In an attempt to determine agreement in identifying glaucoma progression among four providers at a glaucoma practice—including two ophthalmologist glaucoma specialist and two optometrists—researchers used multiple glaucoma tests in a team model. The study also assessed which tests resulted in higher agreement levels and those tests favored by providers to base their decisions on glaucoma progression.
The providers were blinded to the patient’s identity, previous assessments, the identity of the patient’s provider and assessments made by their colleagues in this two-year prospective study of 200 patients (399 eyes). The doctors independently reviewed patients’ clinical data, disc photographs, OCT and visual fields.
The doctors then rated each eye as either “progression” or “no progression of glaucomatous disease.” Investigators looked for three different diagnosis trends: agreement among optometrists, agreement among glaucoma specialists and agreement among all providers.
The study found the two optometrists agreed with each other’s diagnosis 74.2% of the time, while the glaucoma specialists agreed with each other 78.7% of the time. All four providers agreed with each other 54.4% of the time.
Providers had the highest agreement rate when the progression decision was based on disc hemorrhage (92%), while the lowest agreement rate was based on OCT progression analysis (36%). Compared with optometrists, the study found glaucoma specialists used OCT more frequently to determine disease progression.
“Fair to moderate agreement levels were found among providers in their assessment of glaucoma progression, suggesting that a team approach to glaucoma management may be effective,” researchers said. But they also noted that “there is room for improvement, which could be met by further refinement of the definition of glaucoma across the team,” especially regarding the role of OCT in glaucoma diagnosis.
|Shah S, Choo C, Odden J, et al. Provider agreement in the assessment of glaucoma progression within a team model. J Glaucoma. June 4, 2018. [Epub ahead of print].|