Background The specialty-registration of independent prescribing (IP) was introduced for optometrists in 2008, which extended their roles including into acute ophthalmic services (AOS). The present study is the first since IP’s introduction to test concordance between IP optometrists and consultant ophthalmologists for diagnosis and management in AOS. Methods The study ran prospectively for 2 years at Manchester Royal Eye Hospital (MREH). Each participant was individually assessed by an IP optometrist and then by the reference standard of a consultant ophthalmologist; diagnosis and management were recorded on separate, masked proformas. IP optometrists were compared to the reference standard in stages. Cases of disagreement were arbitrated by an independent consultant ophthalmologist. Cases where disagreement persisted after arbitration underwent consensus-review. Agreement was measured with percentages, and where possible kappa ( Κ ), for: diagnosis, prescribing decision, immediate management (interventions during assessment) and onward management (review, refer or discharge). Results A total of 321 participants presented with 423 diagnoses. Agreement between all IP optometrists and the staged reference standard was as follows: ‘almost perfect’ for diagnosis ( Κ = 0.882 ± 0.018), ‘substantial’ for prescribing decision ( Κ = 0.745 ± 0.034) and ‘almost perfect’ for onward management (0.822 ± 0.032). Percentage-agreement between all IP optometrists and the staged reference standard per diagnosis was 82.0% (CI 78.1–85.4%), and per participant using stepwise weighting was 85.7% (CI 81.4–89.1%). Conclusions Clinical decision-making in MREH’s AOS by experienced and appropriately trained IP optometrists is concordant with consultant ophthalmologists. This is the first study to explore and validate IP optometrists’ role in the high-risk field of AOS.

中文翻译：

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急诊眼科独立处方验光师和眼科顾问医师在临床决策方面的协议

背景 2008 年为验光师引入了独立处方 (IP) 的专业注册，这将他们的角色扩展到包括急性眼科服务 (AOS)。本研究是自 IP 引入测试 IP 验光师和顾问眼科医生之间的 AOS 诊断和管理一致性以来的第一项研究。方法 该研究在曼彻斯特皇家眼科医院 (MREH) 进行了 2 年的前瞻性研究。每个参与者都由 IP 验光师单独评估，然后由眼科顾问的参考标准进行评估；诊断和管理记录在单独的掩蔽形式上。分阶段将 IP 验光师与参考标准进行比较。意见不一的情况由独立顾问眼科医生进行仲裁。仲裁后仍存在分歧的案件进行协商一致审查。一致性用百分比和可能的 kappa (Κ) 来衡量，用于：诊断、处方决定、即时管理（评估期间的干预）和后续管理（审查、转诊或出院）。结果 共有 321 名参与者提出了 423 项诊断。所有 IP 验光师与分阶段参考标准之间的一致性如下：诊断“几乎完美”（Κ = 0.882 ± 0.018），处方决定“基本”（Κ = 0.745 ± 0.034）和后续管理“几乎完美”（ 0.822±0.032）。所有 IP 验光师与每个诊断的分阶段参考标准之间的百分比一致性为 82.0% (CI 78.1–85.4%)，使用逐步加权的每位参与者为 85.7% (CI 81.4–89.1%)。结论 由经验丰富且经过适当培训的 IP 验光师在 MREH 的 AOS 中做出的临床决策与顾问眼科医生一致。这是第一项探索和验证 IP 验光师在 AOS 高风险领域中的作用的研究。