Effectiveness of a telemedicine program for triage and diagnosis of emergent ophthalmic conditions

Abstract

Background To study the utility of a teleophthalmology program to diagnose and triage common ophthalmic complaints presenting to an ophthalmic emergency room. Methods Prospective, observational study of 258 eyes of 129 patients presenting to the Massachusetts Eye and Ear Infirmary Emergency Ward (MEE EW) who completed a questionnaire to gather chief complaint (CC), history of present illness, and medical history. Anterior and posterior segment photographs were collected via iPhone 5 C camera and a Canon non-mydriatic fundus camera, respectively. Ophthalmic vital signs were collected. All information was reviewed remotely by three ophthalmologists; a diagnosis and urgency designation were recorded. The remote assessment was compared to gold standard in-person assessment. Results The 129 recruited patients collectively contributed 220 visual complaints, of which 121 (55%) were from females with mean age 56.5 years (range 24–89). Sensitivities and specificities for telemedical triage were as follows: eye pain ( n = 56; sensitivity: 0.58, CI [0.41, 0.74]; specificity: 0.91, CI [0.80, 1]), eye redness ( n = 54; 0.68, CI [0.50, 0.86]; 0.93, CI [0.84, 1]), blurry vision ( n = 68; 0.73, CI [0.60, 0.86]; 0.91, CI [0.80, 1]), and eyelid complaints ( n = 42; 0.67, CI [0.43, 0.91]; 0.96, CI [0.89, 1]). The remote diagnostic accuracies, as stratified by CC, were eye pain (27/56; 48.21%), eye redness: (32/54; 59.26%), blurry vision: (30/68; 44.11%), eyelid (24/42; 57.14%). Conclusions Telemedical examination of emergent ophthalmic complaints consisting of a patient questionnaire, anterior segment and fundus photos, and ophthalmic vital signs, may be useful to reliably triage eye disease based on presenting complaint.

Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers

“…When considering the onsite ophthalmologist's exam and recommendations as the gold standard, the sensitivity and specificity for identification of cupping were 0.92 and 0.83, and the sensitivity and specificity for the follow-up recommendations were 0.71 and 0.65. These values are comparable with the sensitivity and specificity observed in other teleophthalmology programs [24]. Together, these data indicate that the performance of the mobile retinal camera is on par with existing technology in use in terms of sensitivity and specificity [25], as well as in terms of inter-rater reliability.…”

Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology

“…Physician training and easy-to-use platforms for patients can overcome these limitations. Telemedical examination of emergent ophthalmic complaints consisting of a patient questionnaire, anterior segment and fundus pictures and ophthalmic vital signs, may be useful to reliably triage eye disease based on presenting complaints [21]. The main studies dealing with the applications of telemedicine in various ocular disorders are reported in Table 1 [21][22][23][24][25][26].…”

“…Telemedical examination of emergent ophthalmic complaints consisting of a patient questionnaire, anterior segment and fundus pictures and ophthalmic vital signs, may be useful to reliably triage eye disease based on presenting complaints [21]. The main studies dealing with the applications of telemedicine in various ocular disorders are reported in Table 1 [21][22][23][24][25][26]. Due to the frequent presence of opaque dioptric media (e.g., cataract), tele-ophthalmology programs with non-mydriatic fundus camera have a higher rate of non-updatable images.…”

“…The following check-up visits may also be performed through telemedicine channels (see Section 3.2) in order to evaluate the conditions of the transplant and the adequacy of topical therapy. In case of suspicion of corneal worsening/rejection/decompensation, an assessment in the presence of the Ophthalmologist becomes necessary [18,21,26].…”

Telemedicine Training in Ophthalmology Residency Programs

“…7,8 Several specific advantages to the use of ophthalmic telemedicine have been identified including the provi-sion of care to patients with limited access to tertiary eye care centers across state lines 9 and the screening of urgent ophthalmic conditions. [10][11][12] Continued innovation signals that ophthalmic telemedicine will likely play a role in future patient care. 4 However, the preparedness of physicians to perform telemedicine is still an open question.…”