Educating Patients with Neovascular AMD about its Treatment and Low Vision Support Services Available to Them: An Evaluation from the Patient and Clinician Perspective
Authors: Jessica Boyle, Meri Vukicevic, Konstandina Koklanis, Catherine Itsiopoulos, Gwyneth Rees
Aust Orthopt J 2019 Volume 51: 4-16
Abstract: Anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD) is chronic and invasive. Patient education can play a key role in reducing treatment burden. The experiences of patients undergoing anti-VEGF injections for AMD with respect to patient education have not been widely investigated, with just a few small, single-centre investigations having been undertaken. Furthermore, no study has explored issues affecting patient referral to low vision services and patient support groups in this clinical population, from the perspective of ophthalmologists and orthoptists. This study aimed to: i) investigate the experiences of AMD patients undergoing anti-VEGF treatment in relation to patient education, and ii) identify issues surrounding patient referral to support services according to ophthalmologists and orthoptists.
Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited from a private ophthalmology practice and public hospital in Melbourne, Australia. Patients participated in semistructured interviews regarding the information and patient education they received about their eye condition and its management. Interviews were audio recorded and thematic analysis performed. In addition, eighteen orthoptists and one ophthalmologist, recruited from the same locations, completed a self-administered questionnaire exploring the provision of patient education and referral of patients to support groups and low vision services.
Patient satisfaction with the quantity of educational information received was low, especially in public patients. Many patients reported receiving inadequate information about AMD and its treatment. Patient awareness and uptake of low vision services and support groups was poor. Factors influencing uptake (as per patients) included: timing of referral, financial outlay, perceived benefits and accessibility. Barriers to patient referral (as per orthoptists) included: practical and knowledge-based factors, patient factors and clinical protocols.
Many patients felt uninformed about their treatment and also reported limited knowledge of available support services. Improving the provision of patient education and more consistent referral to support services may lessen treatment-related anxiety and assist patients to better manage the challenges of AMD treatment.
Gaze Behaviour and Accuracy among Novice and Glaucoma Specialist Orthoptists During Optic Disc Examination: A Cross Sectional Study
Authors: Jane Scheetz, Konstandina Koklanis, Myra McGuinness, Maureen Long, Meg E Morris
Aust Orthopt J 2019 Volume 51: 17-24
Abstract:
Aim: To examine the extent to which level of clinical experience of orthoptists influences eye movements, gaze behaviour and diagnostic accuracy when examining optic disc images for glaucoma.
Methods: Eye movements and gaze behaviour of participating orthoptists were recorded whilst examining 20 optic disc images for signs of glaucoma. A maximum of 90 seconds was given per image to perform the examination. At the conclusion of each examination, participants were asked to determine whether it was unlikely, possible, probable or certain that the optic disc image had glaucoma. The main outcome measures were examination time, number of fixations, time spent on areas of interest, gaze behaviour and glaucoma likelihood agreement between orthoptist groups.
Results: A total of 41 orthoptists (36 novices and 5 glaucoma specialist orthoptists) agreed to participate. Using multivariable linear regression, there was no difference in optic disc examination times between orthoptist groups or for the total number of fixations made. Those with more experience made significantly more fixations when assessing images with possible signs of glaucoma (p = 0.024). Glaucoma specialist orthoptists methodically examined the optics disc, visualising areas most likely to display glaucomatous damage. Novice orthoptists displayed random gaze behaviours and spent more time looking at areas less likely to display change. Glaucoma likelihood agreement was higher for glaucoma specialist orthoptists (K = 0.51) compared to novices (K = 0.31).
Conclusion: Glaucoma specialist orthoptists adopt a systematic gaze behaviour when examining the optic disc for glaucoma and achieved higher agreement when determining glaucoma likelihood.
Orthoptics Australia Workforce Survey 2017
Authors: Neryla Jolly, Julia Kelly, Sue Silveira, Mara Giribaldi
Aust Orthopt J 2019 Volume 51: 25-30
Abstract:
Purpose: This paper presents the results of the 2017 Orthoptics Australia Workforce Survey (OWS). The results are compared and contrasted with the outcome of the previous 2012-2013 OWS.
Method: The 2017 OWS was implemented using the online tool - SurveyMonkey. All financial members of Orthoptics Australia were contacted to participate in the OWS. To achieve maximum uptake, non-OA members were also encouraged by colleagues to participate in the workforce survey, through publicity at annual conferences and via social media.
Results: Three hundred and twenty-eight orthoptists responded to the 2017 OWS. The profession continues to be female dominated (88.7%), with a young workforce (49.9% between 20-39 years), and high levels of Australian nationality (94%). Most respondents (79.9%) worked in metropolitan NSW (46.7%) or Victoria (31.1%). The main components of current orthoptic employment included public sector (24.9%) and salaried positions in the private sector (52.5%), with 89.5% working in orthoptic related clinical work. Levels of satisfaction with current hours of work were high (91.3%), with 56% indicating their intention to continue to work in an orthoptic-related field for more than the next 10 years.
Conclusion: The 2017 OWS provides a broad overview of the current orthoptic workforce and modes of practice in Australia. These comprehensive survey results can be applied to workforce development, and are available to government and health bodies for future eye health care planning.