1 Discipline of Orthoptics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, Australia 2 Department of Ophthalmology, Austin Health, Melbourne, Australia
Background: The aim of this study was to investigate the intergrater agreement between orthoptists and ophthalmologists in the diagnosis and clinical pathway or management decisions of patients with diabetes presenting to an orthoptist-led diabetic photography clinic in a tertiary hospital in Victoria.
Methods: A sample of patients who attended an orthoptist-led diabetic screening clinic during a 12-month period were selected for inclusion. A senior orthoptist and principal ophthalmologist were provided the de-identified clinical notes and retinal images of these patients and their agreement on the diagnosis and referral pathway management was analysed.
Results: A total of 100 patients, 200 eyes, were included in the study. Agreement between the orthoptist and the ophthalmologist in identifying signs of retinopathy or diabetic macular oedema was noted for 188 (94%) of the eyes assessed, demonstrating near perfect agreement (κ = 0.913; CI 0.854, 0.972). Agreement for the referral recommendation was 82%, showing substantial agreement between practitioners (κ = 0.667; CI 0.536, 0.798), with the urgency of the review agreed upon in 91% of cases with substantial inter-rater agreement (κ = 0.673; CI 0.475, 0.871).
Conclusion: Substantial to near-perfect inter-rater agreement was found between the orthoptist and ophthalmologist in the care of patients referred for diabetic eye screening. This suggests that there may be a role for trained orthoptists in the screening and monitoring of diabetic patients.