Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses

Abstract

AimsTo evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2).MethodsA primary care practice (PCP)–based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants’ local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis.ResultsOf 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (±SD) of 60.6±11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2.ConclusionsThis screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg.Trial registration numberNCT02390245.

Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Cataract Classifications Following Eye Screening

“…29 With regards to the eye screening images in our study, unreadable images may indicate the presence of visually significant cataracts. 30,31 The return rate of participants invited for the visit 2 eye examination was 64.7%, which although slightly higher than observed in our previous study, suggests that there are still barriers to care that remain unaddressed. 32 Due to our targeted population being from underserved areas in Philadelphia, we expected to find high rates of uninsured participants which could pose a barrier for future cataract surgery.…”

A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma

“…The Philadelphia Telemedicine Glaucoma Detection and Followup Study was a prospective, randomized clinical trial that aimed to address the issue of poor adherence to follow-up eye examinations by providing patient navigator and social worker support to directly guide participants through the eye care process (22). The 5-year study was conducted by Wills Eye Hospital, funded by the Centers for Disease Control and Prevention, and registered with ClinicalTrials.gov (NCT02390245).…”

“…The 5-year study was conducted by Wills Eye Hospital, funded by the Centers for Disease Control and Prevention, and registered with ClinicalTrials.gov (NCT02390245). As described previously (22), the study's 2 phases 1) conducted a practice-based telemedicine screening program for glaucoma and other eye diseases among underserved populations with risk factors for eye disease and 2) evaluated whether a community intervention with patient navigation and social worker support improved access to and use of eye care. The study was approved by the Wills Eye Hospital Institutional Review Board and was conducted in accordance with the Declaration of Helsinki.…”

“…Visual field tests were also performed, and visionrelated quality of life was assessed by using the National Eye Institute Vision Function Questionnaire (NEI-VFQ). Previous publications (22) report extensively on this first phase, including detailed methods and recruitment summary and concordance of the telemedicine eye screening findings and comprehensive examination diagnosis (23).…”

“…From April 2015 through February 2017, 906 participants completed the telemedicine eye vision screening (Visit 1) with their PCP as part of Phase 1 of this 5-year study (Figure 1) (22). On telemedicine reading, 355 participants (39%) were classified as having normal fundus images.…”