Subspecialty Adnexal Ophthalmological Examination Using Telemedicine

Abstract

We studied the clinical outcome of examination of a group of patients with adnexal (eyelid and orbit) conditions. Seventeen patients with adnexal problems were assessed by an ophthalmologist at a distance using telemedicine, and then subsequently by an ophthalmologist in a face-to-face consultation. Measurements such as palpebral aperture, levator muscle function and eyelid skin crease position were recorded. The clinical outcomes from both consultations were recorded independently by the consultants and then compared. The study showed that certain adnexal conditions, such as congenital and involutional ptosis, could be accurately assessed using telemedicine, but that other conditions, such as socket problems in patients who had a previous enucleation or those with non-specific ocular pain with less clear-cut features, were better assessed in a face-to-face consultation. Overall, teleconsultations appeared to be suitable for the assessment of uncomplicated ptosis but not for less well defined conditions. Other factors, such as family dynamics and language problems, also limited the usefulness of the technique.

Evaluating clinical signs in trabeculectomized eyes

“…12 Similarly, evaluation of adnexal ophthalmologic examination revealed that teleconsultation with equipment similar to that employed in this study was suitable for assessing congenital or involutional ptosis, but not for less well-defined conditions such as nonspecific ocular pain. 15 Our study differs from those cited above in that we have assessed the variability of the detection of specific clinical signs rather than the ability of an investigator to assess a given clinical entity.…”

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

“…The range of pathology in this setting is greater than that presenting to specialist clinics for which telemedicine reliability has previously been reported. 5,6 Trivial disagreements included examples such as: healed corneal abrasion vs conjunctivitis, preseptal cellulitis diagnosed by both observers with different management strategies; and postoperative inflammation plus medication toxicity vs postoperative inflammation alone. These were judged so because there was no other risk to the patient.…”

“…[1][2][3][4] The accuracy of an ophthalmic diagnosis using telemedicine has been reported for the assessment of eyelid/orbital pathology, strabismus, glaucoma screening, and postoperative cataract assessment. [5][6][7][8] These studies have suggested telemedicine diagnosis using videoconferencing technology at 384 kbit/s to be reliable and safe for the provision of secondary advice in a majority of clinical studies.…”

A Comparison of In-Person Examination and Video Otoscope Imaging for Tympanostomy Tube Follow-Up

“…9 If telemedicine is to be incorporated into a protocol for follow up of pressure equalization tube surgery, then it needs to be established that video otoscope images are an acceptable replacement for the in-person microscope examination. Some studies have adequately addressed image quality and diagnostic accuracy using inter-provider and intra-provider comparisons in the fields of teleophthalmology [10][11][12][13][14][15] and teledermatology. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Few studies have addressed visualization and image capture in the other telemedicine specialties.…”