Selection considerations when using a 'standard optometrist' to evaluate clinical performance of other eye-care personnel

• Published in: Clinical and experimental optometry 2014-09, Vol.97 (5), p.426-432
• Main Authors: Paudel, Prakash, Cronjé, Sonja, O'connor, Patricia M, Rao, Gullapalli N, Holden, Brien A
• Format: Article
• Language: English
• Subjects: Adult; Clinical Competence; clinical performance; disease detection; Eye Diseases - diagnosis; Female; Health Personnel - standards; Humans; Male; Optometry - manpower; Reproducibility of Results; retinoscopy; Retinoscopy - methods; standard optometrist; vision technician
• ISSN: 0816-4622; 1444-0938
• DOI: 10.1111/cxo.12173

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. 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. 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. 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.