Telemedical diagnosis of anterior segment eye diseases: validation of digital slit-lamp still images

Kumar, Satinder; Kanagasingam, Yogesan; Constable, Ian J.

doi:10.1038/eye.2008.11

Cited by 51 publications

(53 citation statements)

References 14 publications

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“…[9] The aim of the present study was to evaluate the diagnostic accuracy of slit-lamp photographs versus face-to-face clinical examinations for anterior segment disease.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine for corneal disease in rural Nepal

et al. 2014

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Summary We evaluated the diagnostic accuracy of slit-lamp photographs interpreted by telemedicine compared with a conventional clinical examination. A convenience sample of 21 patients with anterior segment disease was enrolled at the Lumbini Eye Institute (LEI) in Bhairahawa, Nepal. An ophthalmologist at the LEI examined each patient and assigned a diagnosis and follow-up interval; this represented the gold standard. An ophthalmic technician then obtained anterior segment photographs of each patient. Slit-lamp photographs and clinical histories were then uploaded to a server for access by three separate readers. These readers, one in Nepal and two in the US, provided a diagnosis and follow-up interval independently. The diagnostic agreement the examiner and all readers was good (kappa=0.75, P<0.0001). The agreement about the follow-up interval between the examiner and all readers was fair, with a kappa coefficient of 0.32 (P<0.0001). However, the agreement was high when comparing the examiner with the reviewer in Nepal (kappa=0.90). The agreement was moderate when comparing the two US-based readers (kappa=0.45). In general, the ophthalmologists in Nepal tended to recommend more rapid follow-up than their US-based counterparts. Our results suggest that the transmission of slit-lamp photographs from satellite clinics and eye heath screening camps to the LEI and elsewhere for review and triage is an effective means of identifying anterior segment pathology.

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“…[9] The aim of the present study was to evaluate the diagnostic accuracy of slit-lamp photographs versus face-to-face clinical examinations for anterior segment disease.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine for corneal disease in rural Nepal

et al. 2014

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“…Apart from the analysis of conjunctival hyperemia there are a lot of applications in ophthalmology and other specializations in medicine using such techniques. In ophthalmology, digital photography and analysis are used for diagnosis of the anterior eye segment [37], for vessel detection in corneal transplants [38], for analyzing the corneal involvement of pterygium conjunctivae [39,40], for noninvasive calculation of hemoglobin in the wide field of emergency medicine [41], for examining rotational stability of intraocular lenses [42], in diagnosis of dry eye [43] and in the observation of side effects of antiglaucomatous treatment [44]. In dermatology they are implemented for measuring erythema and edema of the skin prick test [45,46,47] or intradermal skin tests [48], for analyzing repigmentation during treatment of vitiligo [49], for quantification of skin lesions [50], and in diagnosis and treatment of atopic dermatitis [51,52].…”

Section: Introductionmentioning

confidence: 99%

Objectifying the Conjunctival Provocation Test: Photography-Based Rating and Digital Analysis

Dogan

Astvatsatourov

Deserno

et al. 2013

Int Arch Allergy Immunol

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Background: Patients with allergic rhinoconjunctivitis are susceptible to both nasal and ocular symptoms. The conjunctival provocation test (CPT) is an established diagnostic procedure used in allergic rhinoconjunctivitis, particularly to document a patient's current reactivity to allergens. To date, there are no international guidelines defining the CPT. No approved evaluation method exists for interpreting CPT results. This paper aims to establish the digital analysis of macroimages as an objective, validated and standardized method for interpreting CPT results. Methods: In a clinical immunotherapy trial with 155 patients, treatment progress was documented based on the CPT. Local investigators used a symptom score to grade tearing, reddening and the patients' subjective perception of symptoms (mucosal irritation). A central observer rated conjunctival hyperemia via digital photography. Digital image analysis software was utilized to determine conjunctival hyperemia. Results: Spearman's correlation between the local investigators' and the central observer's ratings was r = 0.729 (p < 0.001); the percentage of total agreement was 48% (based on 739 photos). Digital image analysis (based on 48 photos) had a high percentage of total agreement with the central observer's ratings (69%) but a low percentage of total agreement with the investigators' ratings (38%). The corresponding correlations were r = 0.264 and 0.064, respectively. Conclusion: Photography-based rating by a central observer may represent a valuable supplement to the local investigator's assessment for making an objective evaluation of CPT results. Digital image analysis possesses the potential of being an objective evaluation method compared to the wide-spread subjective evaluation by the investigators.

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“…The resolution of the video observed by the remote viewer may never be as high as that observed in person, which may hold implications for medical liability and responsibility. 11 The video streaming of surgical procedures demonstrated herein should only be used when absolutely necessary. Ophthalmic surgery often requires fine detailed stereoscopic view for the detection of, for example, location of the posterior capsule and presence of vitreous prolapse.…”

Section: Discussionmentioning

confidence: 99%