Optometry and Vision Sciences - Theses
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ItemThe utility of clinical audit and point-of-care tools to support optometric evidence-based practice in age-related macular degeneration( 2021)Age-related macular degeneration (AMD) is a leading cause of vision impairment worldwide. Currently, there are no approved therapies for earlier stages of AMD. Furthermore, treatments available for later stages of the disease may not reverse vision loss. Of key importance for reducing patients’ risk of progression to sight-threatening late-stage AMD, is the early identification and management of modifiable risk factors. Optometrists in Australia have a key role in providing primary eye care to people who are at risk of developing, or who have earlier stages of, AMD. They are therefore ideally placed to ask and counsel their patients about lifestyle modifications that can reduce the risk of disease progression. Our research team has recently developed the Macular Degeneration Clinical Care Audit Tool (MaD-CCAT), which is designed to audit the optometric care provided to people with AMD, relative to current best-practice standards. The first research project described in this thesis used self-audit data, collected by optometrists using the MaD-CCAT, to both characterise current optometric AMD practice patterns, and evaluate whether the process of clinical self-audit and receiving analytical feedback could improve AMD care. The second project involved a randomised, placebo-controlled trial to evaluate the efficacy of a novel AMD point-of-care clinical tool, delivered either in hardcopy (paper) or online format, for improving optometrists’ AMD knowledge and documented clinical care. In the first project it was found that there are several areas for improvement relating to optometrists’ documentation patterns for key areas relating to AMD care. In addition, self-audit with feedback significantly improved optometrists’ clinical record documentation, including: AMD risk factors, clinical examination techniques, AMD severity classification, and management, post-audit. The optometric practice patterns observed in this study were used to inform the development of two new AMD clinical tools designed to support evidence-based care. In the second study, use of the point-of-care AMD clinical tools, particularly in a paper-based format, was found to improve clinical record documentation, post-intervention (p<0.05), for documenting: patients’ current smoking status, nutritional supplementation intake, accurate AMD severity classification, discussing patient’s risk of progression to late-stage AMD, and providing advice regarding appropriate dietary and nutritional supplementation intake. Clinical self-audit with analytical feedback is a valuable method for improving clinical record documentation of key aspects of AMD care provision by optometrists. Furthermore, AMD point-of-care clinical tools, particularly in a paper-based format assist in documentation of patient risk factors, AMD severity classification, and facilitating communication with patients regarding modifiable risk factor advice. These studies provide insight into the efficacy of different clinical methods for enhancing optometric AMD care provision, to align with current, best available research evidence.
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ItemCharacteristics of tritanopia and other researches into defective colour vision( [1964])The so called "red-green" forms of defective colour vision are relatively common and have been actively studied since the end of the nineteenth century. Helmholtz (1909) and other German physiologists and physicists made the first precise colorimetric-investigations of human vision. Since this "German period" the study of colour vision was pursued principally by Anglo-saxon physicists and physiologists. In 1935, Pitt published his monograph Characteristics of Dichromatic Yision and W. D. Wright published his Researches on Normal and Defective Colour Vision in 1947. Both these publications continue to form a foundation for current research in defective colour vision. Whilst our knowledge of "red-green" defective colour vision became remarkably accurate and detailed the so called "Blue-yellow" defects were neglected. Wright (1947) refers briefly to tritahopia and tritanomaly commenting that "the amount of reliable information about tritanopia is meagre" (p297) and that "no tritanomalous observers have yet been discovered who could make tests at the colorimeter" (p320). The comparitive rarity of these blue-yellow colour vision defects was the principal reason for the neglect. Wright (1947) at the time suggested the incidences of tritanopia and tritanomaly were both one in a million but warned that these figures "are necessarily very approximate" (p303). However Schmidt (1943) had screened 21,000 visitors to an exhibition and found one case of tritanomaly. The rarity of these two defects is to some extent the product of the kind of screening tests employed. The Ishihara plates make no attempt to test for "blue-yellow" defects and the Nagel anomaloscope uses the Rayleigh equation. An attempt to modify the Nagel anomaloscope to provide a BG equation was not successful (Jaeger 1955). The Stilling pseudo-iso chromatic plates included some plates for the detection of blue-yellow defects, but the Ishihara suplanted this test in many countries. The identification of blue-yellow defects in mass and routine colour vision testing was made practicable by Farnsworth. Farnsworth (1943) produced his Farnsworth-Munsell 100 Hue test and has devised single pseudoisomatic plates which have been shown to be a very effective means of identifying this class of colour vision defect (Jaeger, 1955). One of these plates was used by Wright (1952) in a mass survey which yielded 17 confirmed cases of tritanopia. On the basis of this survey Wright calculated that the incidence of tritanopia was between 1 in 13,000 and 1 in 65,000, the higher freauency being the more likely. This is a much higher incidence than the 1 in 1,000,000 that had suggested previously, but much lower than the 2 in 100 of red-green dichromats among men.