Reliability of telemedicine for diagnosing and managing eye problems in accident and emergency departments

Bowman, Robert J; Kennedy, Craig; Kirwan, James; Sze, P.K.; Murdoch, Ian

doi:10.1038/sj.eye.6700489

Cited by 31 publications

(35 citation statements)

References 11 publications

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“…38–40,42,45,47–49,53 Some research did not include sensitivity analyses 43,46,51,53,54 and some research describes implementation of technologies rather than validation. 43,46,48,52,53 Portable anterior segment photography with mobile phone camera devices has been evaluated. 41,44 Barsam and colleagues provided a descriptive technique of anterior segment slit lamp photography with the iPhone.…”

Section: Discussionmentioning

confidence: 99%

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Woodward

Musch

Hood

et al. 2017

Cornea

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Purpose Corneal and anterior segment diseases cause the majority of urgent visits to eye-care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from two portable cameras for telemedicine purposes. Methods A prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A corneal specialist provided the gold-standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for presence of pathology. Accuracy to detect disease was compared to gold standard diagnosis, stratified by camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal). Results 198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54–71% for iTouch and 66–75% for Nidek, across graders; specificity ranged from 82–96% for iTouch and 91–98% for Nidek. Inter-grader reliability was moderate to strong (kappa ranges: 0.54–0.71 for iTouch; 0.75–0.76 for Nidek. Quality ratings were variable between graders. Conclusions External photographs taken by standard, non-enhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.

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Section: Discussionmentioning

confidence: 99%

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Woodward

Musch

Hood

et al. 2017

Cornea

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“…In another study involving a range of eye problems, in-person examinations using slit lamps were compared with remote video examinations at 384 Kbps using slit lamps or torchlight. 12 The percentage of clinically important disagreement was the same for the slit lamp conditions (just 5% of cases), but doubled with torchlight. A third slit lamp strabismus assessment study found full agreement in 80% of the cases, but the 384 Kbps transmission rate was a problem in cases involving micro-eye movements.…”

Section: Ahrq Specialty Studiesmentioning

confidence: 89%

“…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.…”

Section: Telemedicine Application Principlesmentioning

confidence: 94%

“…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.…”

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confidence: 99%

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

Locatis

Ackerman

2013

Telemedicine and e-Health

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The Agency for Healthcare Research and Quality sponsored two telemedicine research reviews. The latest review concluded that telemedicine is most relevant to specialties, such as psychiatry and neurology, where high levels of patient interaction are crucial to assessment. Telemedicine research studies cited in the reviews having positive findings in the specialties of ophthalmology, otolaryngology, obstetrics and gynecology, gastroenterology, and cardiology and more recent research in these areas are reviewed to identify criteria other than degree of interaction for determining the appropriateness of telemedicine interventions. These criteria include congruity or the extent that procedures used in telemedicine are similar to those of in-person examination, fidelity or the degree to which the information used for assessment in remote examinations is of similar quality to that used in-person, and reliability or the consistency with which information can be gathered and transmitted.

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“…The study demonstrated that accident and emergency teleconsultations can be technically reliable and effective in reducing the number of patient transfers and in a manner acceptable to the referring clinicians. Similarly, Bowman et al [59] conducted a controlled trial to assess the accuracy of telemedicine in diagnosing and managing eye problems presented to accident and emergency. The study has shown that telemedicine, utilizing video slit lamp images, to be an effective, safe, and accurate method of diagnosing and managing these patients.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine Services for the Arctic: A Systematic Review

Woldaregay¹,

Walderhaug²,

Hartvigsen³

2017

JMIR Med Inform

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BackgroundTelemedicine services have been successfully used in areas where there are adequate infrastructures such as reliable power and communication lines. However, despite the increasing number of merchants and seafarers, maritime and Arctic telemedicine have had limited success. This might be linked with various factors such as lack of good infrastructure, lack of trained onboard personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather conditions, remoteness, and other geographical challenges.ObjectiveThe purpose of this review was to assess and analyze the current status of telemedicine services in the context of maritime conditions, extreme weather (ie, Arctic weather), and remote accidents and emergencies. Moreover, the paper aimed to identify successfully implemented telemedicine services in the Arctic region and in maritime settings and remote emergency situations and present state of the art systems for these areas. Finally, we identified the status quo of telemedicine services in the context of search and rescue (SAR) scenarios in these extreme conditions.MethodsA rigorous literature search was conducted between September 7 and October 28, 2015, through various online databases. Peer reviewed journals and articles were considered. Relevant articles were first identified by reviewing the title, keywords, and abstract for a preliminary filter with our selection criteria, and then we reviewed full-text articles that seemed relevant. Information from the selected literature was extracted based on some predefined categories, which were defined based on previous research and further elaborated upon via iterative brainstorming.ResultsThe initial hits were vetted using the title, abstract, and keywords, and we retrieved a total of 471 papers. After removing duplicates from the list, 422 records remained. Then, we did an independent assessment of the articles and screening based on the inclusion and exclusion criteria, which eliminated another 219 papers, leaving 203 relevant papers. After a full-text assessment, 36 articles were left, which were critically analyzed. The inter-rater agreement was measured using Cohen Kappa test, and disagreements were resolved through discussion.ConclusionsDespite the increasing number of fishermen and other seafarers, Arctic and maritime working conditions are mainly characterized by an absence of access to health care facilities. The condition is further aggravated for fishermen and seafarers who are working in the Arctic regions. In spite of the existing barriers and challenges, some telemedicine services have recently been successfully delivered in these areas. These services include teleconsultation (9/37, 24%), teleradiology (8/37, 22%), teledermatology and tele-education (3/37, 8%), telemonitoring and telecardiology (telesonography) (1/37, 3%), and others (10/37, 27%). However, the use of telemedicine in relation to search and rescue (SAR) services is not yet fully exploited. Therefore, we foresee that these implemented and evaluated telemedicine servic...

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Reliability of telemedicine for diagnosing and managing eye problems in accident and emergency departments

Abstract: Objectives To assess the accuracy and efficiency of telemedicine in diagnosing and managing eye problems presenting to accident and emergency departments.

Cited by 31 publications

References 11 publications

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

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

Telemedicine Services for the Arctic: A Systematic Review

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