In this interview we sit down with Dr. Jane Scheetz post-doctoral research fellow; Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
And we’ll discuss her most recent JCEHP article, “A Randomized Trial to Increase the Assessment Accuracy of Glaucoma and Optic Disc Characteristics by Orthoptists.”
Here’s a sneak peek at what we discussed:
1. What was the problem or question you set out to answer?
- A surge in conditions causing moderate to severe vision impairment is placing significant strain on the ophthalmic workforce. This is primarily caused by increases in the prevalence of chronic diseases and our ageing population.
- The ophthalmic workforce, especially ophthalmology, isn’t expanding at a proportionate rate to deal with chronic conditions such as glaucoma which require constant review.
- Orthoptists are well placed within the multidisciplinary health care team to ease demand and take on extended scope of practice roles as they currently work in conjunction with ophthalmologists and arguably possess the skills required to assess and co-manage glaucoma.
- Orthoptists in Australia are performing increased scope of practice roles in glaucoma but there is no published evidence to suggest they are accurate in their assessments. We also don’t know the level of accuracy of general orthoptists and whether they are able to improve/perform at an acceptable level.
- Aim: To investigate the outcomes of targeted education on the accuracy and validity of the assessment of glaucoma and the optic disc by orthoptists.
2. What were the methods you applied to answer the question?
- We recruited both glaucoma specialist orthoptists and general orthoptists to participate in the study so we could see a range of skill levels and how additional education impacted their level of accuracy.
- All participants performed the GONE image assessment which consisted of 42 images. For each image, participants needed to assess 9 optic nerve characteristics and then based on the assessment make a decision as to the likelihood the image was glaucomatous.
- On completion participants were randomized into an educational intervention group or control group.
- Those in the educational group received an online training course which covered ways to assess the 9 optic nerve characteristics and what was considered normal and abnormal.
- The online training course was developed in conjunction with 2 glaucoma specialist ophthalmologists and an expert orthoptist who all had experience in developing and delivering educational material to post graduate health professionals.
- After a period of 4 weeks, all participants repeated the GONE assessment to compare changes in the level of agreement.
3. What did you learn? What do we know now that we didn’t know before?
- We learnt that those who received online education showed improvement compared to those who didn’t. This was significantly greater for identifying hemorrhages, retinal nerve fibre layer defects, disc size, peripapillary atrophy and glaucoma likelihood between attempts. When compared to the control group, the education group showed significantly more improvement when assessing hemorrhages, disc size, disc shape and cup shape.
- Orthoptists who received education were able to achieve levels of accuracy on par with general ophthalmologists
- We learnt that a short online educational package can assist in improving examination skills when assessing fundus photographs for glaucomatous change.
- We also learnt what the baseline accuracy of orthoptists in Victoria, Australia is, and that they have the skill level necessary to make decisions about the likelihood that a patient has glaucoma based on the appearance of their optic nerve.
4. How do you think this could be applied in practice?
- This training program could be delivered to all new clinical orthoptists or those who require upskilling when working in glaucoma clinics
- Because the training was done online it is easily accessible to anyone in the profession
- This type of training could be built upon to include face to face examinations with patients to determine level of skill in real world settings.
- Could be used for benchmarking to determine which clinicians are suitable to take on increased scope of practice roles in glaucoma.
If you are interested in accessing the educational activities that Dr. Scheetz has created and validated, please reach out to her directly at firstname.lastname@example.org
If you learned something with this episode please share the lessons and share the link with your colleagues – the Almanac is now fully open access, meaning everyone in your organization or professional social network can benefit!
Please feel free to reach out if you have suggestions on folks you’d like to see us interview. Or Maybe there are published articles you would like to see deconstructed or simplified…just let us know. You can contact me through LinkedIn or Twitter at @briansmcgowan.
Keep in mind that with every educational program we build there are a thousand opportunities to ask a research question, and with every research article that is published there are dozens of lessons to learn. You don’t have to be a research scientist to build great training experiences, but you do need to embrace what the literature says and move past the status quo.
Thanks for joining us and until next time, NEVER STOP LEARNING.