Selection considerations when using a ‘standard optometrist’ to evaluate clinical performance of other eye‐care personnel

Abstract

Background

Selection of a standard professional is crucial for assessing the clinical performance of other eye‐care personnel. This paper describes the selection considerations and the clinical competency assessment of two optometrists required to select a ‘standard optometrist’ (SO) for evaluating the clinical performance of vision technicians in India.

Methods

Two optometrists were short‐listed from 21 optometrists who responded to an advertisement to be selected as a SO for the assessment of the performance of 24 vision technicians in rural vision centres. Each candidate optometrist performed a routine eye examination on 40 randomly selected, newly registered subjects in a tertiary hospital clinic. Their non‐cycloplegic retinoscopic findings were compared with those of an experienced optometrist, while disease diagnoses were compared with the findings of an ophthalmologist.

Results

A comparison of retinoscopic findings showed that optometrist A produced retinoscopic values within ±0.50 D agreement for the spherical equivalent (SE) 100 per cent of the time, while optometrist B obtained agreement 91.3 per cent of the time. Similarly, optometrist A's limits of agreement (SE = ‐0.63 to +0.45 D) and reproducibility limits (SE = 0.78 D) were better than those of optometrist B (SE = ‐0.98 to +0.70 D and SE =1.18 D, respectively). Optometrist A demonstrated 89.2 per cent sensitivity in detecting ocular pathology compared to 76.3 per cent by optometrist B.

Conclusions

Optometrist A achieved consistent and reproducible retinoscopic findings as well as higher sensitivity in detecting ocular pathology and was selected as the SO for a study to assess the clinical performance of one‐year trained vision technicians. The concept of a SO calibrated against an ophthalmologist for disease detection and diagnosis and an experienced optometrist for retinoscopy is a useful approach for the evaluation of eye‐care personnel.

Key words:

• clinical performance
• disease detection
• retinoscopy
• standard optometrist
• vision technician

Acknowledgements

The authors thank Dr Thomas Naduvilath for his statistical advice and the LV Prasad Eye Institute staff for their extensive support during the study visits. The participating optometrists and ophthalmologists who helped are also acknowledged for their contribution.

Financial support for this study was provided by the Vision Cooperative Research Centre, Australia and the Brien Holden Vision Institute, Australia.

Additional information

Funding

Vision Cooperative Research Centre, Australia

Brien Holden Vision Institute, Australia