Patient-reported outcome measures may aid retina management
Researchers in Spain identified and recommended patient-reported outcome measures for clinical use in individuals with age-related macular degeneration or diabetic retinopathy in a new study.
While patient-reported outcome measures (PROMs) are common in ophthalmology, the researchers recognized a lack of options for patients with AMD or diabetic retinopathy (DR), specifically in Spanish clinics.
“The use of PROs will contribute to shifting clinical practice toward patient-centered medicine,” María Cinta Puell, MD, of the Universidad Complutense de Madrid, and colleagues wrote.
Puell and colleagues collected data using the RAND/UCLA Appropriateness Method (RUAM), which integrates scientific evidence and the opinions of an expert panel by applying the two-round Delphi method. The researchers applied RUAM to articles addressing AMD/DR outcome measures published between 2005 and 2018 in English and Spanish. A panel of 14 Spanish ophthalmologists scored the outcome measures from 1 (extremely irrelevant) to 9 (maximum relevance) for use in Spain.
Investigators defined relevance as the “importance of each outcome measure in clinical practice for early diagnosis and outcomes follow-up.” They classified reported measures rated less than 4 as not recommended, measures rated from 4 to 6 as “may be recommended,” and measures rated 7 or greater as recommended.
Puell and colleagues identified 33 PROM and two treatment satisfaction questionnaires for visual function, AMD, DR and AMD/DR. The panel recommended 11 of the 64 AMD and seven of the 61 DR PROMs.
“This might help ophthalmologists since they may focus on the recommendations instead of evaluating all other available outcome measures,” Puell and colleagues wrote.
“In summary, we believe that the AMD and DR outcome measures recommended in this study will help ophthalmologists choose the most appropriate of the existing outcome measures for managing their patients.”
Perspective
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As optometrists, we all want to have good outcomes for the care we deliver. However, choosing measurement tools can be difficult. While this paper attempts to determine appropriate outcome measures for AMD and DR, it has several shortcomings.
First, the panel of experts assembled are from a single country, Spain. Another significant problem is that they did not rely on the literature or validation studies to determine their opinions, and, as such, their opinions were likely biased by their knowledge of or exposure to the different instruments.
For example, the Pelli Robson contrast test was recommended for use, but the Mars contrast test was scored as not recommended. However, as part of its development, the Mars test was validated against the Pelli Robson and it achieves comparable results. In fact, clinically, the Mars test is easier to use in the optometric setting.
Optometry is a learned profession, and as such we should look to the literature and form our own opinions about which tests and surveys are most appropriate for our patient populations.
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