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Diagnostic Accuracy of Technology-based Eye Care Services: The Technology-based Eye Care Services Compare Trial Part I.

Abstract

PURPOSE

Ophthalmologic telemedicine has the ability to provide eye care for patients remotely, and many countries have used screening tele-ophthalmology programs for several years. One such initiative at the Veterans Affairs (VA) Healthcare System is Technology-based Eye Care Services (TECS). The TECS services are located in primary care clinics and provide basic screening eye care, including vision, refraction, and retinal photography. Eye care providers ("readers") review the clinical data and recommend appropriate follow-up. One of the most common referrals from TECS has been for glaucoma, and this study was powered for glaucoma/glaucoma suspect detection. The current study was undertaken to identify aspects of the protocol that could be refined to enhance accuracy.

DESIGN

Prospective comparison between the standard TECS protocol versus a face-to-face (FTF) examination on 256 patients, all of whom had no known history of significant ocular disease.

PARTICIPANTS

Patients with no known ocular disease who were scheduled for an in-person eye appointment at the Atlanta VA. Patients underwent screening through the TECS protocol and received an FTF examination on the same day (gold standard). The TECS readers were masked to the results of the FTF examination.

MAIN OUTCOME MEASURES

Percent agreement, kappa, sensitivity, and specificity were calculated for the TECS readers' interpretations versus the FTF examination.

RESULTS

The TECS readers showed substantial agreement for cataract (κ ≥ 0.71) and diabetic retinopathy (κ ≥ 0.61) and moderate to substantial agreement for glaucoma/glaucoma suspect (κ ≥ 0.52) compared with an FTF examination. Age-related macular degeneration (AMD) showed moderate agreement (κ ≥ 0.34). Percent agreement with the TECS protocol was high (84.3%-98.4%) for each of the disease categories. Overall sensitivity and specificity were ≥75% and ≥55%, respectively, for any diagnosis resulting in referral. Inter-reader and intra-reader agreement was substantial for most diagnoses (κ > 0.61) with percent agreements ranging from 66% to 99%.

CONCLUSIONS

Our results indicate that the standard TECS protocol is accurate when compared with an FTF examination for the detection of common eye diseases. The inclusion of additional testing such as OCT could further enhance diagnostic capability.

Authors+Show Affiliations

TECS Division, Regional Telehealth Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia. Electronic address: amaa@emory.edu.Bascom Palmer Eye Institute, University of Miami, Miami, Florida.TECS Division, Regional Telehealth Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.TECS Division, Regional Telehealth Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia.Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina.Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina.New York Eye and Ear Infirmary, New York, New York.TECS Division, Regional Telehealth Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia.Emory University School of Medicine, Atlanta, Georgia; Ophthalmology Division, Surgical Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31522900

Citation

Maa, April Y., et al. "Diagnostic Accuracy of Technology-based Eye Care Services: the Technology-based Eye Care Services Compare Trial Part I." Ophthalmology, 2019.
Maa AY, Medert CM, Lu X, et al. Diagnostic Accuracy of Technology-based Eye Care Services: The Technology-based Eye Care Services Compare Trial Part I. Ophthalmology. 2019.
Maa, A. Y., Medert, C. M., Lu, X., Janjua, R., Howell, A. V., Hunt, K. J., ... Lynch, M. G. (2019). Diagnostic Accuracy of Technology-based Eye Care Services: The Technology-based Eye Care Services Compare Trial Part I. Ophthalmology, doi:10.1016/j.ophtha.2019.07.026.
Maa AY, et al. Diagnostic Accuracy of Technology-based Eye Care Services: the Technology-based Eye Care Services Compare Trial Part I. Ophthalmology. 2019 Aug 13; PubMed PMID: 31522900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic Accuracy of Technology-based Eye Care Services: The Technology-based Eye Care Services Compare Trial Part I. AU - Maa,April Y, AU - Medert,Charles M, AU - Lu,Xiaoqin, AU - Janjua,Rabeea, AU - Howell,Ashley V, AU - Hunt,Kelly J, AU - McCord,Sarah, AU - Giangiacomo,Annette, AU - Lynch,Mary G, Y1 - 2019/08/13/ PY - 2019/05/02/received PY - 2019/07/01/revised PY - 2019/07/26/accepted PY - 2019/9/17/entrez PY - 2019/9/17/pubmed PY - 2019/9/17/medline JF - Ophthalmology JO - Ophthalmology N2 - PURPOSE: Ophthalmologic telemedicine has the ability to provide eye care for patients remotely, and many countries have used screening tele-ophthalmology programs for several years. One such initiative at the Veterans Affairs (VA) Healthcare System is Technology-based Eye Care Services (TECS). The TECS services are located in primary care clinics and provide basic screening eye care, including vision, refraction, and retinal photography. Eye care providers ("readers") review the clinical data and recommend appropriate follow-up. One of the most common referrals from TECS has been for glaucoma, and this study was powered for glaucoma/glaucoma suspect detection. The current study was undertaken to identify aspects of the protocol that could be refined to enhance accuracy. DESIGN: Prospective comparison between the standard TECS protocol versus a face-to-face (FTF) examination on 256 patients, all of whom had no known history of significant ocular disease. PARTICIPANTS: Patients with no known ocular disease who were scheduled for an in-person eye appointment at the Atlanta VA. Patients underwent screening through the TECS protocol and received an FTF examination on the same day (gold standard). The TECS readers were masked to the results of the FTF examination. MAIN OUTCOME MEASURES: Percent agreement, kappa, sensitivity, and specificity were calculated for the TECS readers' interpretations versus the FTF examination. RESULTS: The TECS readers showed substantial agreement for cataract (κ ≥ 0.71) and diabetic retinopathy (κ ≥ 0.61) and moderate to substantial agreement for glaucoma/glaucoma suspect (κ ≥ 0.52) compared with an FTF examination. Age-related macular degeneration (AMD) showed moderate agreement (κ ≥ 0.34). Percent agreement with the TECS protocol was high (84.3%-98.4%) for each of the disease categories. Overall sensitivity and specificity were ≥75% and ≥55%, respectively, for any diagnosis resulting in referral. Inter-reader and intra-reader agreement was substantial for most diagnoses (κ > 0.61) with percent agreements ranging from 66% to 99%. CONCLUSIONS: Our results indicate that the standard TECS protocol is accurate when compared with an FTF examination for the detection of common eye diseases. The inclusion of additional testing such as OCT could further enhance diagnostic capability. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/31522900/Diagnostic_Accuracy_of_Technology-based_Eye_Care_Services:_The_Technology-based_Eye_Care_Services_Compare_Trial_Part_I L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(19)31878-0 DB - PRIME DP - Unbound Medicine ER -