Joy Myint

A national survey of diagnostic tests reported by UK community optometrists for the detection of chronic open angle glaucoma

Citation information: Myint J, Edgar DF, Kotecha A, Murdoch IE & Lawrenson JG. A national survey of diagnostic tests reported by UK community optometrists for the detection of chronic open angle glaucoma. Ophthalmic Physiol Opt 2011, 31, 353–359. doi: 10.1111/j.1475‐1313.2011.00844.x

Barriers perceived by UK‐based community optometrists to the detection of primary open angle glaucoma

Purpose:  This paper aims to identify the barriers to case‐finding for primary open angle glaucoma (POAG) as perceived by community optometrists in the United Kingdom (UK).

Development of a competency framework for optometrists with a specialist interest in glaucoma

PurposeTo develop a competency framework, using a modified Delphi methodology, for optometrists with a specialist interest in glaucoma, which would provide a basis for training and accreditation.MethodsA modified iterative Delphi technique was used using a 16-member panel consisting almost exclusively of sub-specialist optometrists and ophthalmologists. The first round involved scoring the relevance of a draft series of competencies using a 9-point Likert scale with a free-text option to modify any competency or suggest additional competencies. The revised framework was subjected to a second round of scoring and free-text comment. The Delphi process was followed by a face-to-face structured workshop to debate and agree the final framework. The version of the framework agreed at the workshop was sent out for a 4-month period of external stakeholder validation.ResultsThere was a 100% response to round 1 and an 94% response to round 2. All panel members attended the workshop. The final version of the competency framework was validated by a subsequent stakeholder consultation and contained 19 competencies for the diagnosis of glaucoma and 7 further competencies for monitoring and treatment.ConclusionsApplication of a consensus methodology consisting of a modified Delphi technique allowed the development of a competency framework for glaucoma specialisation by optometrists. This will help to shape the development of a speciality curriculum and potentially could be adapted for other healthcare professionals.

Does optometrists’ self-reported practice in glaucoma detection predict actual practice as determined by standardised patients?

Citation information: Theodossiades J, Myint J, Murdoch IE, Edgar DF & Lawrenson JG. Does optometrists’ self‐reported practice in glaucoma detection predict actual practice as determined by standardised patients? Ophthalmic Physiol Opt 2012, 32, 234–241. doi: 10.1111/j.1475‐1313.2012.00898.x

The impact of postgraduate training on UK optometrists' clinical decision-making in glaucoma

To investigate the impact of a postgraduate training module on optometrists’ clinical decision‐making in relation to the diagnosis and management of primary open‐angle glaucoma.

The relationship between visual function and performance in rifle shooting for athletes with vision impairment

Background Paralympic sports provide opportunities for those who have an impairment that might otherwise be a barrier to participation in regular sporting competition. Rifle shooting represents an ideal sport for persons with vision impairment (VI) because the direction of the rifle can be guided by auditory information when vision is impaired. However, it is unknown whether those with some remaining vision when shooting with auditory guidance would be at an advantage when compared with those with no vision at all. If this were the case then it would be necessary for those with and without remaining vision to compete in separate classes of competition. Materials and method The associations between shooting performance and 3 measures of visual function thought important for shooting were assessed for 10 elite VI shooters currently classified as VI. A conventional audiogram was also obtained. Results The sample size, though small, included the majority of European VI shooters competing at this level. The relationships between visual functions and performance confirmed that individuals with residual vision had no advantage over those without vision when auditory guidance was available. Auditory function was within normal limits for age, and showed no relationship with performance. Summary The findings suggest that rifle-shooting athletes with VI are able to use auditory information to overcome their impairment and optimise performance. Paralympic competition should be structured in a way that ensures that all shooters who qualify to compete in VI shooting participate within the same class irrespective of their level of VI.

Agreement among optometrists and ophthalmologists in estimating limbal anterior chamber depth using the van Herick method

To evaluate the inter‐observer agreement for measuring limbal anterior chamber depth (LACD) using the van Herick test in community optometrists, glaucoma specialist optometrists and ophthalmologists.

Functional visual fields: relationship of visual field areas to self-reported function

The aim of this study is to relate areas of the visual field to functional difficulties to inform the development of a binocular visual field assessment that can reflect the functional consequences of visual field loss.

The Level of Vision Necessary for Competitive Performance in Rifle Shooting: Setting the Standards for Paralympic Shooting with Vision Impairment

The aim of this study was to investigate the level of vision impairment (VI) that would reduce performance in shooting; to guide development of entry criteria to visually impaired (VI) shooting. Nineteen international-level shooters without VI took part in the study. Participants shot an air rifle, while standing, toward a regulation target placed at the end of a 10 m shooting range. Cambridge simulation glasses were used to simulate six different levels of VI. Visual acuity (VA) and contrast sensitivity (CS) were assessed along with shooting performance in each of seven conditions of simulated impairment and compared to that with habitual vision. Shooting performance was evaluated by calculating each individual’s average score in every level of simulated VI and normalizing this score by expressing it as a percentage of the baseline performance achieved with habitual vision. Receiver Operating Characteristic curves were constructed to evaluate the ability of different VA and CS cut-off criteria to appropriately classify these athletes as achieving ‘expected’ or ‘below expected’ shooting results based on their performance with different levels of VA and CS. Shooting performance remained relatively unaffected by mild decreases in VA and CS, but quickly deteriorated with more moderate losses. The ability of visual function measurements to classify shooting performance was good, with 78% of performances appropriately classified using a cut-off of 0.53 logMAR and 74% appropriately classified using a cut-off of 0.83 logCS. The current inclusion criteria for VI shooting (1.0 logMAR) is conservative, maximizing the chance of including only those with an impairment that does impact performance, but potentially excluding some who do have a genuine impairment in the sport. A lower level of impairment would include more athletes who do have a genuine impairment but would potentially include those who do not actually have an impairment that impacts performance in the sport. An impairment to CS could impact performance in the sport and might be considered in determining eligibility to take part in VI competition.

Contrast sensitivity is a significant predictor of performance in rifle shooting for athletes with vision impairment

Purpose: In order to develop an evidence-based, sport-specific minimum impairment criteria (MIC) for the sport of vision-impaired (VI) shooting, this study aimed to determine the relative influence of losses in visual acuity (VA) and contrast sensitivity (CS) on shooting performance. Presently, VA but not CS is used to determine eligibility to compete in VI shooting. Methods: Elite able-sighted athletes (n = 27) shot under standard conditions with their habitual vision, and with their vision impaired by the use of simulation spectacles (filters which reduce both VA and CS) and refractive blur (lenses which reduce VA with less effect on CS). Habitual shooting scores were used to establish a cut-off in order to determine when shooting performance was ‘below expected’ in the presence of vision impairment. Logistic regression and decision tree analyses were then used to assess the relationship between visual function and shooting performance. Results: Mild reductions in VA and/or CS did not alter shooting performance, with greater reductions required for shooting performance to fall below habitual levels (below 87% of normalized performance). Stepwise logistic regression selected CS as the most significant predictor of shooting performance, with VA subsequently improving the validity of the model. In an unconstrained decision tree analysis, CS was selected as the sole criterion (80%) for predicting ‘below expected’ shooting score. Conclusion: Shooting performance is better predicted by losses in CS than by VA. Given that it is not presently tested during classification, the results suggest that CS is an important measure to include in testing for the classification of vision impairment for athletes competing in VI shooting.