The Clinical Skills of Optometrists in Assessing the Anterior Chamber Angle

Introduction The number of cases of glaucoma is predicted to increase considerably over the next few decades. The current reference standard method used to distinguish between primary open angle and primary angle closure glaucoma is gonioscopy, but there is a lack of evidence on anterior chamber angle (ACA) assessment methods outside Asia. Optometrists who show competence at gonioscopy are well placed to play an important future role in glaucoma care provision in the UK. Aims: To investigate the impact of the NICE guideline on glaucoma on the clinical practice of optometrists. To investigate the ability of optometrists and other healthcare professionals (HCPs) at gonioscopy. To assess the intra-observer repeatability and agreement between gonioscopy, van Herick method and anterior segment Optical Coherence Tomography (AS-OCT). Methods Optometrists were invited to complete an online questionnaire investigating clinical practice before and after the introduction of the NICE guideline. Gonioscopy findings for optometrists and other HCPs were compared to those of a consultant ophthalmologist. Sensitivity and specificity were calculated, weighted kappa (κw) was used to assess inter-observer repeatability. Gonioscopy, van Herick method and AS-OCT were performed on two occasions. Sensitivity and specificity of van Herick method and AS-OCT were calculated, using gonioscopy as the reference standard. Kappa (κ) was used to measure the intraobserver repeatability. Results A significant increase in the use of applanation tonometry (p < 0.01) but no significant change in gonioscopy usage (p=0.47) was found after the introduction of the NICE guideline. Sensitivity and specificity values for HCPs’ gonioscopy findings compared to a consultant ophthalmologist were good: 92% and 92% respectively. The repeatability of gonioscopy was fair κ=0.29, while that of the van Herick method (κ=0.54) and AS-OCT (κ=0.47) were better. The van Herick method showed good sensitivity (visit 1: 82%, visit 2: 75%) and very good specificity (visit 1: 88%, visit 2: 95%). The sensitivity of AS-OCT was fair (visit 1: 46%, visit 2: 25%), specificity was high (visit 1: 87%. visit 2: 89%). Discussion In this thesis new evidence is presented comparing ACA assessment tests. There has been no change in gonioscopy practice since the guideline on glaucoma was issued. Optometrists along with other HCPs, are able to perform gonioscopy accurately and competently. The van Herick method and AS-OCT have better repeatability than gonioscopy. The van Herick method showed good agreement with gonioscopy but AS-OCT agreement with gonioscopy was less. The van Herick method would therefore appear to be a more useful test than AS-OCT for optometrists assessing patients at risk of glaucoma

Applying product design methods to medical device design with a case study on home care devices

Thesis (Master)--Izmir Institute of Technology, Industrial Design, Izmir, 2004Includes bibliographical references (leaves: 142)Text in English; Abstract: Turkish and Englishxii, 150 leavesMedical device design is one of the most important and most promising fields of industrial design. Medical devices, which were once designed by doctors, technicians and other people, who usually use such devices, have become insufficient in meeting the needs of today.s. In this respect, design of such devices and methods, which are used in the design process, comes away as main topics, which have to be carefully undertaken.Product design methods have the capacity of solving the problems of medical device design field, as they have in many other fields. In this study, the ways of applying these methods into the medical device design process, especially in home care medical device design, are going to be examined

Unbecoming Cinema: Unsettling encounters with ethical event films

Unbecoming Cinema constitutes a welcome addition to texts that provide a film-philosophical perspective on films that otherwise take on and involve difficult subject matter, including in this case suicide, autistic worldviews, hallucinatory aesthetics and vomit-gore. The book in effect argues successfully and intelligently that even though hard to watch, many of these films can provide for viewers an opportunity to come to a renewed understanding of self and world. As a result, the author takes on difficult topics, but brings them to life in an exciting, philosophical fashion that also asks readers to rethink what it is that constitutes cinema

Ultrasonic two-dimensional imaging of the heart with multiscan

The introduction of the prototype of an ultrasonic linear array scanner in 1971, confronted us with a type of diagnostic information which was different from conventional cardiac imaging techniques. With the use of ultrasound, cardiac structures were now displayed in a direct and positive manner rather than as shadows or negative impressions in contrast media as seen with X-ray and angiocardiographic techniques. Imaging in multiple new planes through the heart now became possible. These planes were difficult or impossible to visualize With other techniques. Therefore hardly any knowledge about the anatomic information in these images existed. The major aim of this thesis is to present the implementation into the clinical practice of cardiology of the linear array system which was developed at the Thoraxcenter in Rotterda

Optical coherence tomography: evaluation and clinical application

The ability to examine the appearance of the retina is of paramount importance for the diagnosis and monitoring of ophthalmic disease and for the evaluation of treatment outcomes. Direct cross-sectional imaging of retinal structure could be useful for early diagnosis and more sensitive monitoring of a variety of retinal conditions such as macular oedema and glaucoma. The view of the fundus given by ophthalmoscopy provides very limited depth information and clinicians will often have to resort to additional techniques such as flourescein angiography or visual field testing for information on structural abnormalities within the retina. Other currently available imaging techniques do not provide sufficient depth resolution to produce useful cross-sectional images of retinal structure. Optical coherence tomography (OCT) is a new imaging technique which is capable of producing cross-sectional images of the retina with a resolution that surpasses that of conventional imaging techniques. This new technique has axial resolution of around 1 O.tm and can resolve individual retinal layers, thus providing information on retinal structure. In principle, OCT is very similar to ultrasound however it makes use of a light source rather than an acoustic one. The technique is non-contact and non-invasive and is generally well tolerated by patients. This thesis describes the evaluation of this new imaging technique with regards to its potential within routine clinical practice. A number of investigations were performed to fuffil this evaluation. Tests were carried out to experimentally measure the system's resolution and the accuracy and precision of measurements made from the OCT scans. A number of factors that could affect the quality of the scans were identified and their effects were minimised wherever possible. The software provided with the system was rigorously tested and potential sources of error were identified. Various studies were undertaken to quantify the repeatability and reproducibility of measurements made from scans and normative values were established. These results were used to assess the ability of the technique to detect and quantify several retinal disorders. The potential of the technique for corneal imaging was investigated - a scanning protocol was established and customised software for processing cornea! scans was developed. The relationship between OCT bands and retinal morphology was investigated by correlating scans from canine retina with corresponding light microscopy images and by observing the position of retinal abnormalities on scans from patients with a variety of conditions that affected different parts of the retina. Finally the clinical potential of OCT was investigated by carrying out various studies on a number of retinal conditions. Further clinical studies which combine anatomical information from OCT with functional information from electrophysiology are currently underway. Current developments are aimed at improving the imaging processing features and user interface so as to provide a more robust, user-friendly system for routine clinical use