Physician recognition of ophthalmoscopic signs of open-angle glaucoma
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Objective:To evaluate a short educational intervention instructing primary care physicians in the recognition of glaucomatous changes of the optic disc.
Design:Comparison of performances on a pretest and a posttest consisting of fundus slides in color.
Setting:Educational conferences at two university-affiliated teaching hospitals and one staff-model bealth maintenance organization.
Subjects:Thirty-six internal medicine residents and ten practicing internists.
Intervention:A 20-minute slide/narration educational program, which covered diagnostic criteria for openangle glaucoma, normal and abnormal optic disc anatomy, and funduscopic signs of open-angle glaucoma.
Measurements and main results:Following the intervention, residents showed improved sensitivity (0.76 to 0.88, p=0.007), specificity (0.65 to 0.88, p<0.001), and accuracy (0.71 to 0.88, p<0.001). Internists showed similar increments in sensitivity, specificity, and accuracy: 0.67 to 0.86 (p=0.01), 0.59 to 0.84 (p=0.01), and 0.63 to 0.85 (p=0.002), respectively.
Conclusion:A brief educational intervention can result in meaningful improvement in physician diagnostic accuracy in recognizing ophthalmoscopic signs of open-angle glaucoma.
- Leske MC. The epidemiology of open-angle glaucoma: a review. Am J Epidemiol 1983;118:166–91.
- Hollows FC, Graham PA. Intraocular pressure, glaucoma and glaucoma suspects in a defined population. Br J Ophthalmol 1966;50:570–86.
- Podgor MJ, Leske MC, Ederer F. Incidence estimates for lens changes, macular changes, open-angle glaucoma, and diabetic retinopathy. Am J Epidemiol 1983;118:206–12.
- Gottlieb LK, Schwartz B, Pauker SG. Glaucoma screening: a cost-effectiveness analysis. Surv Ophthalmol 1983;28:206–26. CrossRef
- Keltner JL, Johnson CA. Screening for visual field abnormalities with automated perimetry. Surv Ophthalmol 1983;28:175–83. CrossRef
- Canadian Task Force on the Periodic Health Examination. The periodic health examination: 2. 1985 update. Can Med Assoc J 1986;134:724–7.
- Steinmann WC, Soper K, Weisenthal R, Stone RA, Nichols CW, Bloom L. Fundoscopy as a screening test by internists (abstr). Clin Res 1983;31:646A.
- Schwartz B. Changing perspectives on screening for ocular disease. Surv Ophthalmol 1983;28:141–3. CrossRef
- Margolis KL, Money BE, Kopietz LA, Randall D, Rich EC. Evaluation of two interventions to improve physician diagnostic accuracy in recognizing glaucomatous changes of the optic disk. Proc Annu Conf Res Med Educ 1987;28–33.
- Packer H, Deutsch AR, Deweese MW, Kashgarian M, Lewis PM. Efficiency of screening tests for glaucoma. JAMA 1965;192:109–12.
- Steinmann WC, Licht E, Siegler JE, Nichols CW. Screening for glaucoma by general medicine residents. Arch Intern Med 1982;142:785–6. CrossRef
- Douglas GR, Drance SM, Schulzer M. A correlation of fields and discs in open angle glaucoma. Can J Ophthalmol 1974;9:391–8.
- Hitchings RA, Spaeth GL. The optic disk in glaucoma, II. Correlation of the appearance of the optic disc. Br J Ophthalmol 1977;61:107–13.
- Holmin C. Optic disc evaluation versus the visual field in chronic glaucoma. Acta Ophthalmol 1982;60:275–83. CrossRef
- Hoskins HD, Gelber EC. Optic disk topography and visual field defects in patients with increased intraocular pressure. Am J Ophthalmol 1975;80:284–90.
- Sussman EJ, Tsairas WG, Soper KA. Diagnosis of diabetic eye disease. JAMA 1982;247:3231–4. CrossRef
- Lofgren RP. The dynamic nature of sensitivity and specificity. J Gen Intern Med 1987;2:452–3.
- Steinmann WC, Millstein ME, Sinclair SH. Pupillary dilation with tropicamide 1% for funduscopic screening. Ann Intern Med 1987;107:181–4.
- Physician recognition of ophthalmoscopic signs of open-angle glaucoma
Journal of General Internal Medicine
Volume 4, Issue 4 , pp 296-299
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- open-angle glaucoma
- primary care
- periodic health examination
- Industry Sectors
- Author Affiliations
- 1. Division of General Internal Medicine, Department of Medicine, Hennepin County Medical Center, 701 Park Avenue, 55415, Minneapolis, MN
- 2. Department of Medicine (BEM, ECR), St. Paul-Ramsey Medical Center, St. Paul, Minnesota
- 3. Department of Ophthalmology (LAK), St. Paul-Ramsey Medical Center, St. Paul, Minnesota