Abstract：
The aim of this study is to evaluate the diagnosis, staging, imaging and management preferences, and the effect of advanced imaging among practising optometrists in age-related macular degeneration (AMD).
Up to 20 case vignettes (computer-based case simulations) were completed online in a computer laboratory in random order by 81 practising optometrists of Australia. Each case presented findings from a randomly selected patient seen previously at the Centre for Eye Health for a macular assessment in the following order: case history, preliminary tests and colour fundus photography. Participants were prompted to provide their diagnosis, management and imaging preference. One additional imaging result (either modified fundus photographs and infrared images, fundus autofluorescence, or optical coherence tomography [OCT]) was then provided and the questions repeated. Finally, all imaging results were provided and the questions repeated a third time.
A total of 1,436 responses were analysed. The presence of macular pathology in AMD was accurately detected in 94 per cent of instances. The overall diagnostic accuracy of AMD was 61 per cent using colour fundus photography. This improved by one per cent using one additional imaging modality and a further four per cent using all imaging. Across all responses, a greater improvement in the diagnostic accuracy of AMD occurred following the presentation of OCT findings (versus other modalities). OCT was the most preferred imaging modality for AMD, while multimodal imaging was of greatest benefit in cases more often misdiagnosed using colour fundus photography alone. Overall, the cohort also displayed a tendency to underestimate disease severity.
Despite reports that imaging technologies improve the stratification of AMD, our findings suggest that this effect may be small when applied among practising optometrists without additional or specific training.
Up to 20 case vignettes (computer-based case simulations) were completed online in a computer laboratory in random order by 81 practising optometrists of Australia. Each case presented findings from a randomly selected patient seen previously at the Centre for Eye Health for a macular assessment in the following order: case history, preliminary tests and colour fundus photography. Participants were prompted to provide their diagnosis, management and imaging preference. One additional imaging result (either modified fundus photographs and infrared images, fundus autofluorescence, or optical coherence tomography [OCT]) was then provided and the questions repeated. Finally, all imaging results were provided and the questions repeated a third time.
A total of 1,436 responses were analysed. The presence of macular pathology in AMD was accurately detected in 94 per cent of instances. The overall diagnostic accuracy of AMD was 61 per cent using colour fundus photography. This improved by one per cent using one additional imaging modality and a further four per cent using all imaging. Across all responses, a greater improvement in the diagnostic accuracy of AMD occurred following the presentation of OCT findings (versus other modalities). OCT was the most preferred imaging modality for AMD, while multimodal imaging was of greatest benefit in cases more often misdiagnosed using colour fundus photography alone. Overall, the cohort also displayed a tendency to underestimate disease severity.
Despite reports that imaging technologies improve the stratification of AMD, our findings suggest that this effect may be small when applied among practising optometrists without additional or specific training.
摘要：
这项研究的目的是评估诊断，分期,成像和管理偏好，以及在年龄相关性黄斑变性（AMD）的验光师中进行高级成像的效果。
澳大利亚81位执业验光师在计算机实验室以随机顺序在线完成了多达20个案例小插图（基于计算机的案例模拟）。每个病例都按以下顺序从先前在眼健康中心看到的随机选择的患者中进行黄斑评估：病史，初步测试和彩色眼底照相。参与者被提示提供他们的诊断，管理和成像偏好。一个额外的成像结果（修改后的眼底照片和红外图像，眼底自发荧光，或光学相干断层扫描[OCT]）然后提供并重复问题。最后,我们提供了所有影像学检查结果,问题重复了第三次.
共分析了1,436个响应。在94％的病例中准确检测到AMD中黄斑病变的存在。使用彩色眼底照相，AMD的总体诊断准确率为61％。使用一种额外的成像方式，这一比例提高了1%，使用所有成像方式，这一比例提高了4%。在所有回应中，在OCT发现后,AMD的诊断准确性有了更大的提高(与其他方式相比).OCT是AMD最优选的成像模式，而多模态成像在仅使用彩色眼底照相更经常误诊的病例中获益最大。总的来说,该队列还显示出低估疾病严重程度的倾向.
尽管有报道称成像技术改善了AMD的分层，我们的研究结果表明，当在没有额外或特定培训的验光师中应用时，这种影响可能很小。
澳大利亚81位执业验光师在计算机实验室以随机顺序在线完成了多达20个案例小插图（基于计算机的案例模拟）。每个病例都按以下顺序从先前在眼健康中心看到的随机选择的患者中进行黄斑评估：病史，初步测试和彩色眼底照相。参与者被提示提供他们的诊断，管理和成像偏好。一个额外的成像结果（修改后的眼底照片和红外图像，眼底自发荧光，或光学相干断层扫描[OCT]）然后提供并重复问题。最后,我们提供了所有影像学检查结果,问题重复了第三次.
共分析了1,436个响应。在94％的病例中准确检测到AMD中黄斑病变的存在。使用彩色眼底照相，AMD的总体诊断准确率为61％。使用一种额外的成像方式，这一比例提高了1%，使用所有成像方式，这一比例提高了4%。在所有回应中，在OCT发现后,AMD的诊断准确性有了更大的提高(与其他方式相比).OCT是AMD最优选的成像模式，而多模态成像在仅使用彩色眼底照相更经常误诊的病例中获益最大。总的来说,该队列还显示出低估疾病严重程度的倾向.
尽管有报道称成像技术改善了AMD的分层，我们的研究结果表明，当在没有额外或特定培训的验光师中应用时，这种影响可能很小。
