Abstract
Aim: To evaluate feasibility, safety, and clinical efficiency of optometrists in conducting diabetic retinopathy screening and ocular health screening.
 Methods: This was a prospective observational trial study of newly developed optometric service pathways established at a community health clinic for diabetic retinopathy screening and a hospital ophthalmology clinic for ocular health screening. The study was carried out to assess the feasibility and safety of eye examinations conducted by optometrists. Patients were examined by optometrists using a standard eye examination at both clinics and re-examined by ophthalmologists as the reference standard. Optometrists recorded diagnoses of ocular conditions and classified referral urgency for each patient and these were compared with the diagnoses made by ophthalmologists, who were masked to the optometrists’ findings.
 Results: There was a high concordance of 87.0% (95% CI 80.4%-93.6%) for the diagnoses between the optometrists and ophthalmologists. Of 26 patients considered by the optometrists to need ophthalmology referral, 23 were agreed as such by the ophthalmologists, giving good agreement, κ = 0.76 (95% CI 0.53 -0.94) between the optometrists and ophthalmologists on referral classification. Agreement by the ophthalmologists for referral urgency classifications (very urgent/urgent or non-urgent) was very good (κ = 0.85, 95%CI 0.62-1.00).
 Conclusions: Ocular health examination by optometrists using optometric-eyecare pathways is feasible and safe. Optometrists showed strong agreement with ophthalmologists when diagnosing patients who had a range of ocular conditions. Optometrists were also able to triage referrals and their urgency accurately, suggesting that they could play an extensive role as primary eye care providers, thus reducing unnecessary referrals to ophthalmology clinics.
Highlights
In the Malaysian public health system, primary eye care services, general eye examinations and ocular health screening, are mainly undertaken by ophthalmologists in a hospital setting
Malaysian optometrists are trained in ocular pathology, including full eye assessment during undergraduate training, their knowledge and skills are relatively underutilised,[7,8] with the majority of optometrists in public and private sectors undertaking clinical roles limited to refraction in practice
Feasibility and safety of the study protocol The number of patients recruited for eye examinations varied across every clinic session at both locations, depending on how many patients agreed to take part
Summary
In the Malaysian public health system, primary eye care services, general eye examinations and ocular health screening, are mainly undertaken by ophthalmologists in a hospital setting. Unlike many developed countries,[3,4,5] the role of optometrists in Malaysia in providing ocular health assessment is not widely recognised. Malaysian optometrists are trained in ocular pathology, including full eye assessment during undergraduate training, their knowledge and skills are relatively underutilised,[7,8] with the majority of optometrists in public and private sectors undertaking clinical roles limited to refraction in practice. Whilst the provision of refractive services is valuable, optometrists’ potential to be primary eye care providers who can conduct ocular health screening may be valuable for the Malaysian eye care system
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call