PubMed · 14849215
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A W HOWLAND. 1951. Glaucoma; its present concept.. https://pubmed.ncbi.nlm.nih.gov/14849215/
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PURPOSE: To compare patient data retrieval between electronic patient record systems (Eyetrack) and conventional paper records (CPRs). METHODS: A total of 20 long term glaucoma patient records held on Eyetrack were randomised into two collections with 10 CPRs and 10 Eyetrack records in each collection. The Eyetrack records of one collection were the CPRs of the other collection and vice versa. Four doctors, as two groups, were assessed on a separate collection of records. The time taken to answer 10 questions and the accuracy were assessed. Comparison was made of the answers between the two formats. A month later each group was assessed on the 10 CPRs of the other collection. An expert Eyetrack user was assessed on only the 20 Eyetrack notes. Comparison was made between the 20 CPRs the doctors were assessed on and the 20 eyetrack records. RESULTS: In the first comparison, the mean time for all the doctors to answer the questions on a CPR was 324.4(+/-106.0) s compared to 104.8(+/-34.0) s for Eyetrack(Mann-Whitney, P<0.01). Mean accuracy for a CPR was 84.0%(+/-13.0%) compared to 98.0%(+/-4.0%) for Eyetrack(Mann-Whitney, P<0.01). Comparing the expert Eyetrack user with the CPR showed a mean time for Eyetrack of 96.6(+/-34.8) s compared with 283.7(+/-63.9) s for CPR(Mann-Whitney, P<0.0001). Mean accuracy for Eyetrack was 97.5%(+/-7.2%) compared to 82.0%(+/-8.7%) for CPRs(Mann-Whitney, P<0.0001). CONCLUSIONS: An improvement of 3 min 40 s per record was observed with Eyetrack. Accuracy was also improved. Similar results were also found comparing an expert Eyetrack user with CPRs.
Perimetry of some kind remains an important tool in the detection, diagnosis and monitoring of glaucomatous damage to the visual pathway. However, recent studies have served to reinforce the suspicion that conventional perimetry does not possess the sensitivity to detect the earliest signs of functional loss resulting from glaucoma. The relationship between differential light threshold and ganglion cell loss is extremely weak and, in the early stages of glaucoma, non-existent. Alternative, more novel perimetric techniques seem to offer promise of better detectability for early loss by claiming to tap in to one or other of the separate parallel pathways of the visual system. While some of these tests show potential for better detection and monitoring of glaucoma, the reasons why this might be so are not always clearly formulated or represented. This leads to misunderstanding of what the test actually measures and of the glaucomatous disease process itself. This paper seeks to revisit and review the theory underlying psychophysical testing of visual function related to glaucoma and stresses the importance of developing tests that are based on a firm theoretical understanding of visual function and processing in order to both detect glaucoma at an earlier stage and better understand the mechanisms of loss from the disease process.