An audit of disease diagnoses made by optometrists

Abstract

Background: Several Australian ophthalmologists have sworn affidavits that, in their opinion, optometrists have deficient training in the detection of eye disease and systemic disease having ocular manifestations, and are unable to detect a number of medical conditions having ocular manifestations. The deponents swore that optometrists could not make a medical diagnosis because they lack medical Hampton, Victoria training. To test these opinions this report details a prospective comparison of diagnoses made by three optometrists with the diagnosis subsequently made by the ophthalmologist or physician to whom the patients were referred. Methods: All referrals made to ophthalmologists or physicians were recorded, together with the optometrists' diagnoses, which were recorded prior to referral. On receipt of the medical practitioner's report, his or her diagnosis was recorded and compared with the optometrist's diagnosis. Results: Four patients referred to ophthalmologists were lost to follow‐up. Agreement between the optometrist's and ophthalmologist's diagnoses was unequivocally correct in 114 (93.4 per cent) of the 122 referrals for which follow‐up was available. The optometric diagnoses of ophthalmic disease were correct, but incomplete, in six cases and, in two cases (Saltzman's dystrophy and Chandler's syndrome), the optometrist's diagnosis was inappropriate. Referrals to family physicians totalled 18, of which three were lost to follow‐up. Of the remaining 15 patients referred, 12 diagnoses (70 per cent) were correct and three were incorrect. The three incorrect diagnoses were one case of suspected cranial arteritis and two cases of suspected diabetes, or impaired glucose tolerance. There were 38 separate diagnostic conditions referred to ophthalmologists and 11 separate conditions referred to general physicians. Conclusions: The optometrists who conducted this study were able to make diagnoses over a wide range of ocular and systemic diseases. These diagnoses were substantially in agreement with the diagnoses made by ophthalmologists and general physicians. This suggests that die training and clinical experience of optometrists can be adequate to provide a high standard of primary eye care and that optometrists are able to detect disease conditions that require referral to medical practitioners.