Elsevier

Ophthalmology

Volume 115, Issue 12, December 2008, Pages 2127-2131
Ophthalmology

Original article
Assessment of Patient Opinions of Different Clinical Tests Used in the Management of Glaucoma

https://doi.org/10.1016/j.ophtha.2008.08.013Get rights and content

Purpose

To compare different tests used in the clinical management of glaucoma, with respect to the testing experience for patients undergoing each test.

Design

Evaluation of diagnostic tests.

Participants

A total of 101 subjects with high-risk ocular hypertension or early glaucoma.

Methods

Subjects were asked to give their opinion on 7 tests used clinically in glaucoma management by assigning each a score between 0 (absolute dislike) and 10 (perfect satisfaction).

Main Outcome Measure

Tests were ranked for each subject from 1 (favorite test) to 7 (least favorite test) on the basis of patient-assigned scores.

Results

Goldmann applanation tonometry for measurement of intraocular pressure was ranked significantly better than any other test (median rank 2.5, P≤0.01). This was followed by confocal scanning laser ophthalmoscopy using a Heidelberg Retina Tomograph (median rank 3.3); frequency doubling technology perimetry (4.0); multifocal visual evoked potential (4.0); optic nerve photography (4.3); and standard automated perimetry (4.8). Short-wavelength automated perimetry was ranked significantly worse than any other test (median rank 5.3, P≤0.04).

Conclusions

In many cases, statistically significant differences were found between the patients' opinions of the tests. Information on this issue has to date largely been anecdotal or subjective. To our knowledge, this is the most comprehensive study to assess and compare the patient experience when undergoing these tests.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

Subjects were taken from an ongoing longitudinal study of glaucomatous progression at Discoveries in Sight Laboratories, Devers Eye Institute, Portland, Oregon. Subjects with early glaucoma and suspected glaucoma were recruited and have been followed annually for up to 10 years. Detailed inclusion and exclusion criteria, including clinical characteristics, are tangential to this study but have been described elsewhere.12, 13, 14 The study adheres to the tenets of the Declaration of Helsinki and

Results

Figure 2 shows histograms of the raw scores for each test. Table 1 summarizes the raw scores for each of the 7 tests and the by-subject ranks for the 7 tests. IOP was the highest-rated test, followed by HRT and FDT. SWAP received the lowest average score, with 48 subjects ranking SWAP as their least favorite or joint least favorite test. Table 2 shows the 7 tests in order of mean rank, along with P values from pairwise comparisons of ranks.

Discussion

The patient's opinion of a particular test is not the only factor when choosing which tests to perform. The expected clinical utility of the results will generally be the primary consideration. However, the patient's experience is an important factor to consider. For some patients, it is possible that it may affect their willingness to return for follow-up visits and the frequency of visits they will tolerate. In a disease such as glaucoma, which generally progresses slowly, this may be

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      Importantly, our study solicited this information, anonymously and at a distance from any specific clinical or patient environment. Previous research has explored participants, experiences of visual field assessment8,26,27; however, the novel focus of our study was to enquire directly about willingness to vary test duration, number of tests per visit, and visit frequency and to ask people to priority rank areas for future perimetric development and potential translation into practice. Regarding visual field test frequency, a variety of recommendations appear in the literature designed to improve early detection of visual field progression within the first 2 years of initial diagnosis and for monitoring thereafter.11,12,38,39

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    Manuscript no. 2008-499.

    Financial Disclosure(s): No conflicting relationship exists for any author.

    Supported in part by the National Institutes of Health (Bethesda, Maryland) grant EY03424. The funding organization had no role in the design or conduct of this research.

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