The content of optometric eye examinations for a young myope with headaches

• Published in: Ophthalmic & physiological optics 2008-09, Vol.28 (5), p.404-421
• Main Authors: Shah, Rakhee, Edgar, David F., Rabbetts, Ronald, Blakeney, Susan L., Charlesworth, Peter, Harle, Deacon E., Evans, Bruce J. W.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; clinical practice; Eye and associated structures. Visual pathways and centers. Vision; eye examination; Female; Fundamental and applied biological sciences. Psychology; Guideline Adherence - standards; headaches; Health Care Surveys; Humans; Medical sciences; Migraine Disorders - etiology; Myopia - diagnosis; Ophthalmology; optometry; Optometry - methods; Optometry - standards; Patient Simulation; Practice Guidelines as Topic - standards; quality of care; Quality of Health Care - standards; Research Design; standardised patient; Treatment Outcome; Vertebrates: nervous system and sense organs; Vision Tests - methods
• ISSN: 0275-5408; 1475-1313
• DOI: 10.1111/j.1475-1313.2008.00587.x

Background:  A recent review found standardised patient (SP) methodology to be the gold standard methodology for evaluating clinical care. We used this to investigate the content of optometric eye care for a young myopic patient with headaches suggestive of migraine. Methods:  We recruited 100 community optometrists who consented to be visited by an unannounced actor for an eye examination and to have that eye examination recorded. The actor received extensive training to enable accurate reporting of the content of the eye examinations, via an audio recording and a checklist completed for each clinical encounter. The actor presented as a 20‐year‐old student seeking a private eye examination and complaining of symptoms suggestive of migraine headaches. The results of each clinical encounter were recorded on a pre‐designed checklist based on evidence‐based reviews on headaches, clinical guidelines and the views of an expert panel of optometrists. Results:  The presence of headache was detected in 98% of cases. Eight standard headache questions were considered to be the gold standard for primary care headache investigation. Although none of the optometrists asked all of these questions, 22% asked at least four of the eight questions. Sixty‐nine per cent of practitioners asked the patient to seek a medical opinion regarding the headaches. The proportion of the tests recommended by the expert panel that was carried out varied from 33% to 89% and the durations of the eye examination varied from 5 to 50 min. Conclusion:  SP encounters are an effective way of measuring clinical care within optometry and should be considered for further comparative measurements of quality of care. As in research using SPs in other healthcare disciplines, our study has highlighted substantial differences between different practitioners in the duration and depth of their clinical investigations. This highlights the fact that not all eye examinations are the same and that there is no such thing as a ‘standard sight test’. We recommend that future optometric continuing education could usefully focus on migraine diagnosis and assessment.