Indication for Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration Based on Optical Coherence Tomography Interpretation: Decision Agreement Rate between Orthoptist and Ophthalmologist

Yong Ern Lim BHlthSc MOrth(Hons)
Meri Vukicevic PhD
Konstandina Koklanis PhD
Jessica Boyle BOrth&OphthSc BHealthSc(Hons)
Department of Clinical Vision Sciences, Faculty of Health Sciences, La Trobe University, Melbourne, Australia

Objective: Although orthoptists play an integral role in the care of patients with chronic eye diseases, the clinical decision making of orthoptists within this setting has not often been investigated. The aim of this study was to evaluate the inter-rater agreement between orthoptists and an ophthalmologist in determining whether antiVEGF treatment for neovascular (wet) age-related macular degeneration (AMD) is required based on optical coherence tomography (OCT) interpretation.

Methods: A retrospective audit was conducted of patient data from a private ophthalmology practice. Data collected included details pertaining to patient demographics and clinical assessment, OCT retinal thickness, and the treatment decisions of five orthoptists and one senior vitreoretinal ophthalmologist when interpreting OCT scans. The inter-rater agreement between the orthoptists and the ophthalmologist was calculated as a percentage and the kappa (κ) statistic computed.

Results: Of a total 669 treatment decisions made, on 619 occasions (92.5%) agreement was found between the orthoptists and the ophthalmologist (κ = 0.85; 95%CI 3.43 – 1.26, p < 0.001) representing an almost perfect agreement.

Conclusion: Agreement between the orthoptists and ophthalmologist in AMD clinical decision making is very high suggesting that orthoptists could potentially have a greater involvement in shared-care models within specialist eye clinics. Keywords: neovascular age-related macular degeneration, orthoptist, inter-rater agreement, anti-VEGF clinical decision making, optical coherence tomography.