IMPORTANCE Examinations for retinopathy of prematurity (ROP) are typically performed using binocular indirect ophthalmoscopy. Telemedicine studies have traditionally assessed the accuracy of telemedicine compared with ophthalmoscopy as a criterion standard. However, it is not known whether ophthalmoscopy is truly more accurate than telemedicine. OBJECTIVE To directly compare the accuracy and sensitivity of ophthalmoscopy vs telemedicine in diagnosing ROP using a consensus reference standard. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective study conducted between July 1, 2011, and November 30, 2014, at 7 neonatal intensive care units and academic ophthalmology departments in the United States and Mexico included 281 premature infants who met the screening criteria for ROP. EXPOSURES Each examination consisted of 1 eye undergoing binocular indirect ophthalmoscopy by an experienced clinician followed by remote image review of wide-angle fundus photographs by 3 independent telemedicine graders. MAIN OUTCOMES AND MEASURES Results of both examination methods were combined into a consensus reference standard diagnosis. The agreement of both ophthalmoscopy and telemedicine was compared with this standard, using percentage agreement and weighted κ statistics. RESULTS Among the 281 infants in the study (127 girls and 154 boys; mean [SD] gestational age, 27.1 [2.4] weeks), a total of 1553 eye examinations were classified using both ophthalmoscopy and telemedicine. Ophthalmoscopy and telemedicine each had similar sensitivity for zone I disease (78% [95% CI, 71%–84%] vs 78% [95% CI, 73%–83%]; P > .99 [n = 165]), plus disease (74% [95% CI, 61%–87%] vs 79% [95% CI, 72%–86%]; P = .41 [n = 50]), and type 2 ROP (stage 3, zone I, or plus disease: 86% [95% CI, 80%–92%] vs 79% [95% CI, 75%–83%]; P = .10 [n = 251]), but ophthalmoscopy was slightly more sensitive in identifying stage 3 disease (85% [95% CI, 79%–91%] vs 73% [95% CI, 67%–78%]; P = .004 [n = 136]). CONCLUSIONS AND RELEVANCE No difference was found in overall accuracy between ophthalmoscopy and telemedicine for the detection of clinically significant ROP, although, on average, ophthalmoscopy had slightly higher accuracy for the diagnosis of zone III and stage 3 ROP. With the caveat that there was variable accuracy between examiners using both modalities, these results support the use of telemedicine for the diagnosis of clinically significant ROP.
Objective: The aim of this study is to obtain the thoughts, knowledge levels and training needs' of the family medicine residents in Ankara about ophthalmology. Also with this study, we aimed to raise awareness on this issue and guide the studies that aimed to promote standard care for ophthalmology patients. Methods: Between 01/04/2015-01/05/2015, we applied a questionnaire, developed by researchers to the family medicine residents who were working at a training and research/ university hospital in Ankara. We reached to the 200 family medicine residents to join to the survey but 196 of them completed the questionnaire. Data analysis was performed with SPSS 21.0 for Windows application. Results: Only 12.8% of the residents think that the ophthalmology training given in the medicine faculty is enough, but 54.1% of them disagree and 33.2% of them partially agree. It was found that the most common cause of inadequate training in medical faculty is lack of practice. 9.5% of the family medicine residents agree that the ophthalmology training given during the family medicine specialization training is enough but 67.5% of them disagree and 20.5% of them partially agree. Residents think that ophthalmology education in family medicine training is not sufficient because Ophthalmology rotation is optional in the curriculum. Conclusion: The curriculum of family medicine specialization training should include both practical and theorical trainings for the primary health care. In this context, compulsory and elective clinical rotations are an important part of specialization training. Only 9.5% of the participants agree that the ophthalmology training given during the family medicine specialization training is enough. It was thought that the results of the study will raise awareness on this issue and help the new studies about developing the approaches to the patients with eye diseases in primary care.
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