Tags

Type your tag names separated by a space and hit enter

Telemedicine diagnosis of eye disorders by direct ophthalmoscopy. A pilot study.
Ophthalmology. 1998 Oct; 105(10):1907-14.O

Abstract

OBJECTIVE

To report a pilot study of telemedical direct ophthalmoscopy in the diagnosis of acquired immune deficiency syndrome (AIDS)-related retinopathy in a human immunodeficiency virus (HIV)-positive population and in the diagnosis of glaucoma, cataract, and retinopathy in a diabetic population.

DESIGN

Prospective comparative case series.

PARTICIPANTS

Seventeen HIV-positive and 20 diabetic patients.

METHODS

A direct ophthalmoscope custom-fitted with a digital microcamera capable of transmitting images from any of 61 sites within the Georgia Statewide Telemedicine Program was used by a nonophthalmologist to examine 34 eyes of 17 HIV-positive patients and 39 eyes of 20 patients with diabetes. Fundus images were transmitted in real-time to a reviewing ophthalmologist. An in-person, comprehensive examination including indirect ophthalmoscopy, was performed by a second ophthalmologist. Telemedical examination was compared to the in-person comprehensive examination.

RESULTS

For the HIV study, 21 eyes did not show HIV retinopathy (noninfectious retinopathy with cotton-wool spots) by in-person examination. Telemedical examination correctly identified 20 of these eyes as disease-free (specificity = 95%). HIV retinopathy was present in 12 of the 34 eyes by in-person evaluation with telemedical examination correctly diagnosing 10 of these eyes (sensitivity = 83%). One eye with dense cataract and retinal detachment was unable to be evaluated ophthalmoscopically by either in-person or telemedical examination. Telemedical and in-person assessments for HIV retinopathy were identical in 100% of eyes without cataract. Disagreement in diagnosis between telemedical and in-person examination was associated with cataract (P < 0.0007). For the diabetes study, because of an inadequate image, telemedical examination was unable to classify 46% and 36% of eyes for glaucoma and diabetic retinopathy, respectively. Inability to make a telemedical determination for glaucoma (P < 0.011), nonproliferative (P < 0.064) and proliferative (P < 0.064) diabetic retinopathy was associated with cataract. Of the eyes that were able to be assessed by telemedical examination for diabetic retinopathy (n = 25), glaucoma (n = 21), and cataract (n = 39), the accuracy was poor (sensitivity = 29%, 50%, and 41%, respectively). Telemedical examination for diabetic retinopathy and glaucoma was more likely to agree with in-person examination in eyes without cataract as compared to eyes with cataract (not statistically significant).

CONCLUSION

Telemedical direct ophthalmoscopic, real-time fundus imaging may provide a valuable means for providing ophthalmic consultation to the primary care physician in younger patients without lens or media opacity, but is inadequate for eyes with any degree of lens or media opacity.

Authors+Show Affiliations

Department of Ophthalmology, Medical College of Georgia, Augusta 30912-3400, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9787363

Citation

Marcus, D M., et al. "Telemedicine Diagnosis of Eye Disorders By Direct Ophthalmoscopy. a Pilot Study." Ophthalmology, vol. 105, no. 10, 1998, pp. 1907-14.
Marcus DM, Brooks SE, Ulrich LD, et al. Telemedicine diagnosis of eye disorders by direct ophthalmoscopy. A pilot study. Ophthalmology. 1998;105(10):1907-14.
Marcus, D. M., Brooks, S. E., Ulrich, L. D., Bassi, F. H., Laird, M., Johnson, M., & Newman, C. (1998). Telemedicine diagnosis of eye disorders by direct ophthalmoscopy. A pilot study. Ophthalmology, 105(10), 1907-14.
Marcus DM, et al. Telemedicine Diagnosis of Eye Disorders By Direct Ophthalmoscopy. a Pilot Study. Ophthalmology. 1998;105(10):1907-14. PubMed PMID: 9787363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Telemedicine diagnosis of eye disorders by direct ophthalmoscopy. A pilot study. AU - Marcus,D M, AU - Brooks,S E, AU - Ulrich,L D, AU - Bassi,F H, AU - Laird,M, AU - Johnson,M, AU - Newman,C, PY - 1998/10/27/pubmed PY - 1998/10/27/medline PY - 1998/10/27/entrez SP - 1907 EP - 14 JF - Ophthalmology JO - Ophthalmology VL - 105 IS - 10 N2 - OBJECTIVE: To report a pilot study of telemedical direct ophthalmoscopy in the diagnosis of acquired immune deficiency syndrome (AIDS)-related retinopathy in a human immunodeficiency virus (HIV)-positive population and in the diagnosis of glaucoma, cataract, and retinopathy in a diabetic population. DESIGN: Prospective comparative case series. PARTICIPANTS: Seventeen HIV-positive and 20 diabetic patients. METHODS: A direct ophthalmoscope custom-fitted with a digital microcamera capable of transmitting images from any of 61 sites within the Georgia Statewide Telemedicine Program was used by a nonophthalmologist to examine 34 eyes of 17 HIV-positive patients and 39 eyes of 20 patients with diabetes. Fundus images were transmitted in real-time to a reviewing ophthalmologist. An in-person, comprehensive examination including indirect ophthalmoscopy, was performed by a second ophthalmologist. Telemedical examination was compared to the in-person comprehensive examination. RESULTS: For the HIV study, 21 eyes did not show HIV retinopathy (noninfectious retinopathy with cotton-wool spots) by in-person examination. Telemedical examination correctly identified 20 of these eyes as disease-free (specificity = 95%). HIV retinopathy was present in 12 of the 34 eyes by in-person evaluation with telemedical examination correctly diagnosing 10 of these eyes (sensitivity = 83%). One eye with dense cataract and retinal detachment was unable to be evaluated ophthalmoscopically by either in-person or telemedical examination. Telemedical and in-person assessments for HIV retinopathy were identical in 100% of eyes without cataract. Disagreement in diagnosis between telemedical and in-person examination was associated with cataract (P < 0.0007). For the diabetes study, because of an inadequate image, telemedical examination was unable to classify 46% and 36% of eyes for glaucoma and diabetic retinopathy, respectively. Inability to make a telemedical determination for glaucoma (P < 0.011), nonproliferative (P < 0.064) and proliferative (P < 0.064) diabetic retinopathy was associated with cataract. Of the eyes that were able to be assessed by telemedical examination for diabetic retinopathy (n = 25), glaucoma (n = 21), and cataract (n = 39), the accuracy was poor (sensitivity = 29%, 50%, and 41%, respectively). Telemedical examination for diabetic retinopathy and glaucoma was more likely to agree with in-person examination in eyes without cataract as compared to eyes with cataract (not statistically significant). CONCLUSION: Telemedical direct ophthalmoscopic, real-time fundus imaging may provide a valuable means for providing ophthalmic consultation to the primary care physician in younger patients without lens or media opacity, but is inadequate for eyes with any degree of lens or media opacity. SN - 0161-6420 UR - https://www.unboundmedicine.com/medline/citation/9787363/Telemedicine_diagnosis_of_eye_disorders_by_direct_ophthalmoscopy__A_pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(98)91040-5 DB - PRIME DP - Unbound Medicine ER -