Evaluating clinical signs in trabeculectomized eyes

Abstract

Aim To evaluate interobserver agreement for clinical signs in trabeculectomized eyes when examined face-to-face with slit-lamp biomicroscopy (SL) or by remote examination using telemedicine (real-time remote video imaging; TM). Method A system for examining trabeculectomized eyes was devised and validated. A prospective randomized interobserver agreement study was then undertaken to compare standard SL biomicroscopy and TM. Remote examination was performed using a 384 kbps Sony 5100 videoconferencing system. Three ophthalmologists each examined 40 eyes of 40 patients, who had previously undergone trabeculectomy. In rotation, two examiners used SL biomicroscopy. The third examined the eye remotely by TM. Analysis was performed to determine the variability in clinical signs and the presence or absence of systematic bias between ophthalmologists and examination methods. Results High levels of agreement were observed for paired examinations by SL biomicroscopy (SL/SL) for bleb vascularity (score range 0-10) with no systematic bias. Paired examination by SL and TM (SL/TM) also showed good levels of agreement for bleb vascularity, although the spread of disagreement was wider (95% limits of agreement 2.57 vs 2.98 (P ¼ 0.054)). For anterior chamber depth, observers agreed within 710% of anterior chamber depth for 68% of eyes (SL/SL) and 51% of eyes (SL/TM) (P ¼ 0.68). Agreement was 'good' for wall thickness (j ¼ 0.6370.08), bleb height (j ¼ 0.6770.1), and the existence of bleb leak (j ¼ 0.6370.19), but poor for bleb morphology (j ¼ 0.2670.12). For the SL/TM comparison, agreement was fair for wall thickness (j ¼ 0.3970.13), poor for bleb height (j ¼ 0.1770.12), good for bleb leak (j ¼ 0.5670.19), and fair for bleb morphology (j ¼ 0.3170.12). Microcysts were not reliably detected using either technique. Conclusion SL biomicroscopy and TM telemedicine examination may permit reliable clinical assessment of trabeculectomized eyes. However, remote examination with TM is more limited with respect to assessing bleb height and bleb wall thickness. The assessment of bleb morphology and microcysts was unreliable with both instruments. We propose that TM examination of trabeculectomized eyes appears safe and appropriate in situations where face-to-face examination by an ophthalmologist is not practical.

Interobserver Variability of the Würzburg Bleb Classification Score

“…The Indiana Bleb Appearance Grading Scale (IBAGS) [3] and the bleb classification according to Sacu et al [2 ]are grading systems for filtering blebs, which used criteria similar to the WBCS. The most recent bleb grading system is the Moorfields Bleb Grading System (MBGS), which goes back to a telemedicine study [4, 8]. Sacu et al [2] used the WBCS as a basis for their score, and expanded it by the parameters dimension of avascularity, conjunctival transparency, hemorrhage and thin-cystic avascular configuration.…”

“…Recently, several wound healing modulating agents have entered routine clinical practice [1, 2]. In order to guide their use, a thorough slit lamp examination is essential and allows for a timely start of wound-modulating therapy [2,3,4,5,6,7,8]. In clinical practice, scoring systems offer a framework for structured patient examination and facilitate the interpretation of clinical findings.…”

Three Principles for Determining the Relevancy of Store-and-Forward and Live Interactive Telemedicine: Reinterpreting Two Telemedicine Research Reviews and Other Research

“…11,12 Otolaryngology diagnoses were similar when outputs from local audiometric devices were transmitted. 19 The only difference in the otolaryngology 17 and gastroenterology 22,23 DETERMINING THE RELEVANCY OF TELEMEDICINE studies involving endoscopes or otoscopes 32 concerned transmitting local video for remote consultation.…”

“…Patients with trabeculectomized eyes were evaluated in-person using slit-lamp biomicroscopy and by telemedicine in one study. 11 The telemedicine examinations used the same slit-lamp technology, but the images were transmitted by videoconference at a rate of 384 kilobits per second (Kbps), sufficient for full-screen, full-motion, standarddefinition video. Agreement between ophthalmologists examining in-person and remotely was essentially the same.…”

“…The standard-definition video used to transmit patient data in the slit lamp studies had sufficient resolution and motion for remote ophthalmologists to diagnose eye conditions except those involving micro-movement. [11][12][13] In the specialties of obstetrics 14,15,31 Increasing the number of images may add information compensating for data that are missing or inadequately shown in smaller image sets.…”