Investigation of the efficacy of an online diagnostic tool for improving the diagnosis of ocular fundus lesions imaged by Optical Coherence Tomography (OCT)

Background: Novel ocular imaging technology has proliferated within UK community
optometry. Optical Coherence Tomography (OCT) is a pillar of ocular imaging, playing a
central role in retinal disease management. As a non-invasive method for diagnosis and
follow-up of patients with common retinal conditions such as age-related macular
degeneration (AMD) and diabetic macular oedema, OCT is well suited to the primary care
setting of community optometry.
The novel nature of OCT images presents considerable challenges for community
optometrists. AMD prevalence will rise as a consequence of population growth and
unprecedented life expectancy and, despite the emergence of novel treatment options, limited
clinical capacity threatens access to potentially sight-saving treatment. Limited guidance
exists for optometrists using OCT for diagnostic and referral decisions.
Objective: To measure the efficacy of a novel internet resource which, if proven to be
efficacious, could not only aid in the use of OCT for diagnosis of retinal disease and
subsequent patient management but could also play a role in ongoing training of optometrists.
Method: An online diagnostic tool (OCTAID) was designed for diagnosis of central retinal
lesions using OCT. The effectiveness of OCTAID was evaluated by a randomised controlled
trial comparing two groups of practitioners who underwent an online assessment (using
clinical vignettes) of their diagnostic and management skills based on OCT images before and
after an educational intervention. Participants' answers were validated against experts'
classifications (the reference standard). OCTAID was randomly allocated as the educational
intervention for one group with the control group receiving an intervention of standard OCT
material.
Participants: Participants were community optometrists recruited through online optometry
forums
Setting: Internet based application
Results: 53 optometrists (study group) and 65 optometrists (control group) completed the
study (n = 118), forming the analysis population. Both groups performed similarly at baseline
with no significant difference in mean exam 1 scores (p = 0.212). The primary outcome
measure was mean improvement in exam score between the two exam modules. Participants
who received OCTAID improved their exam score significantly more than those who
received conventional educational materials (p = 0.005).
Conclusion: Use of OCTAID is associated with an improvement in the combined skill of
OCT scan recognition and subsequent patient management. There is potential for this mode of
educational delivery in optometric training.
Future work recommendations: With further development, OCTAID could become a
collaborative learner-centred model of OCT education allowing optometrists to take
responsibility for their own learning within a unique professional community.
Funding: Self-funded