The Effect of Imaging on Macular Disease Diagnosis: A Case Vignettes Study of Non-AMD, Macular Disease

Angelica Ly


Purpose: Macular disease is a leading cause of irreversible vision loss. Imaging technologies have the potential to minimize the devastating consequences of these disorders through early detection. The aim of this study was to assess the imaging preferences of practicing Australian optometrists and to evaluate the effect of imaging on the diagnosis and management of macular disease.

Methods: Case vignettes (computer-based case simulations) were designed from ten randomly selected patients seen at the Centre for Eye Health for a macular assessment. Following presentation of the case history, preliminary tests and fundus photography, participants were prompted for their diagnosis, management and imaging preference. One additional imaging result (multispectral images, fundus autofluorescence, or optical coherence tomography – OCT) was then provided and the questions repeated. Final responses were recorded after displaying all imaging results simultaneously. In the allotted time, 82 practicing optometrists completed between one and ten cases each in random order, giving a total of 719 complete responses.

Results: Participants were predominantly female (65%), and aged between 22 and 78 years. The presence of macular pathology was accurately identified in 412/505 instances (82% sensitivity). This improved by 8% adding a single imaging modality and a further 1% using all available imaging results in combination (Cochran’s Q, p < 0.001). There were 21/72 (29%) false positives in round one, 37/72 (51%) in round two and 42/72 (58%) in round three. Across all responses, OCT was most preferred (547/719; 76%). Imaging was also positively associated with a management preference to refer rather than monitor (Cochran’s Q, p < 0.001).

Conclusion(s): Without any additional training, the interpretation of imaging by practicing Australian optometrists was associated with an improvement in diagnosis. However, it was also associated with a higher false positive rate and referral.


Year: 2017

Program Number: 175123

Author Affiliation: Centre for Eye Health

Co-Authors: Lisa Nivison-Smith, Barbara Zangerl, Michael Kalloniatis

Co-Author Affiliation: Centre for Eye Health UNSW Sydney, Centre for Eye Health UNSW Sydney, Centre for Eye Health UNSW Sydney

Room: Hall D