Telemedicine Diagnosis of Cytomegalovirus Retinitis by Nonophthalmologists

Yen, Michael T.; Chen, Jenny; Ausayakhun, Somsanguan; Jirawison, Choeng; Heiden, David; Holland, Gary N.; Margolis, Todd P.; Keenan, Jeremy D.

doi:10.1001/jamaophthalmol.2014.1108

Cited by 25 publications

(12 citation statements)

References 30 publications

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“…4 Conducting the study in Thailand, Yen et al 4 found good agreement between nonexpert and expert graders evaluating 182 fundus photographs: the mean sensitivity and specificity values of nonexpertdiagnosisusingexpertconsensusasthereferencestandardwere 93.2%and88.4%,respectively.Meanintraraterreliabilityalsowashigh (mean κ, 0.83). Training consisted simply of a 2-hour workshop, and there were some raters with lower accuracy.…”

Section: Resultsmentioning

confidence: 98%

Telemedicine Screening for Eye Disease

Kroenke

2015

JAMA

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Telemedicine is increasingly used for disease monitoring and management of chronic medical and mental disorders, but also has screening and diagnostic applications such as teleradiology and teledermatology. Indeed, "therapy at a distance" will complement office-based care in the 21st century. Another screening application is teleophthalmology, in which digital photography with telemedicine links has proven cost-effective for retinal disorders, including diabetic retinopathy and retinopathy of prematurity. 1,2 In a recent study in JAMA Ophthalmology, Chasan et al 3 complemented prior cost-effectiveness analyses of teleretinal screening programs by examining both the accuracy of diabetic teleretinal screening as well as the subsequent eye care use and resources required in such a program. Regarding accuracy, screening tests that have good sensitivity and specificity are likely to be more cost-effective. Regarding resource use, implementation of screening generates more referrals, testing, and procedures. The cost-effectiveness of any screening program is therefore contingent on reasonable test accuracy coupled with a sufficient supply of resources to meet the increased demand.Chasan et al 3 conducted the study in community-based clinics of a single Veterans Affairs (VA) medical center. Of 1935 patients who underwent diabetic retinal screening, 465 (24%) had an abnormal finding on the retinal photograph and were referred to the VA eye clinic, of whom 326 were seen by an eye specialist and had a confirmatory diagnosis. The most common reasons for referral were nonmacular diabetic retinopathy (43.2%), nerve-related disease (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%), and diabetic macular edema (5.6%). The percentage of agreement between retinal screening and the ophthalmic examination for all diagnoses was 90.4%, with a sensitivity of 73.6%. Sensitivity may have been somewhat inflated for 2 reasons. First, only patients with abnormal retinal photographs were referred, thus greatly increasing the number of cases with disease and minimizing the number of cases without disease. This verification bias (also known as "workup bias" or "referral bias") is a type of measurement bias in which the results of a diagnostic test affect whether the gold standard procedure is used to verify the test result. Second, it is not clear that the clinician performing the ophthalmic examina- EXPOSURES Clinical medical records were reviewed for a 2-year period after patients were referred from teleretinal screening. The following information was collected for analysis: patient demographics, referral and confirmatory diagnoses, ophthalmology clinic visits, diagnostic procedures, surgical procedures, medications, and spectacle prescriptions. MAIN OUTCOMES AND MEASURESThe accuracy between referring and final diagnoses and the eye care resources that were used in the care of referred patients. RESULTSThe most common referral diagnoses were nonmacular diabetic retinopathy (43.2%), nerve-related disease (30.8%...

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Section: Resultsmentioning

confidence: 98%

Telemedicine Screening for Eye Disease

Kroenke

2015

JAMA

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“…Telemedicine based diagnosis of retinal diseases has already been validated in various studies for retinopathy of prematurity, diabetic retinopathy, and cytomegalovirus retinitis using conventional standard field fundus photography. [25][26][27][28][29][30][31][32] The use of NMUWF imaging for this purpose would enable a nonophthalmic technician to perform non-contact photography of a wider field than traditional fundus imaging without need for mydriasis and allow improved visualization of peripheral retinal pathology.…”

Section: Discussionmentioning

confidence: 99%

Non-Mydriatic Ultra-Widefield Imaging Compared With Single-Field Imaging in the Evaluation of Peripheral Retinal Pathology

Adhi¹,

Silva²,

Lang³

et al. 2017

Ophthalmic Surg Lasers Imaging Retina

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“…40, 41 Alternate methods could be explored to increase diagnostic capacity, including training primary care providers in indirect ophthalmoscopy 42 and remote diagnosis via telemedicine. 43-45 …”

Section: Discussionmentioning

confidence: 99%

Retinal Detachment Associated With AIDS-Related Cytomegalovirus Retinitis: Risk Factors in a Resource-Limited Setting

Yen

Chen

Kunavisarut

et al. 2015

American Journal of Ophthalmology

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Purpose To determine risk factors predictive of retinal detachment in patients with cytomegalovirus (CMV) retinitis in a setting with limited access to ophthalmic care. Design Case-control study. Methods Sixty-four patients with CMV retinitis and retinal detachment were identified from the Ocular Infectious Diseases and Retina Clinics at Chiang Mai University. Three control patients with CMV retinitis but no retinal detachment were selected for each case, matched by calendar date. The medical records of each patient were reviewed, with patient-level and eye-level features recorded for the clinic visit used to match cases and controls, and also for the initial clinic visit at which CMV retinitis was diagnosed. Risk factors for retinal detachment were assessed separately for each of these time points using multivariate conditional logistic regression models that included 1 eye from each patient. Results Patients with a retinal detachment were more likely than controls to have low visual acuity (OR, 1.24 per line of worse vision on the logMAR scale; 95%CI, 1.16-1.33) and bilateral disease (OR, 2.12; 95%CI, 0.92-4.90). Features present at the time of the initial diagnosis of CMV retinitis that predicted subsequent retinal detachment included bilateral disease (OR, 2.68; 95%CI, 1.18-6.08) and lesion size (OR, 2.64 per 10% increase in lesion size; 95%CI, 1.41-4.94). Conclusion Bilateral CMV retinitis and larger lesion sizes, each of which is a marker of advanced disease, were associated with subsequent retinal detachment. Earlier detection and treatment may reduce the likelihood that patients with CMV retinitis develop a retinal detachment.

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Telemedicine Diagnosis of Cytomegalovirus Retinitis by Nonophthalmologists

Cited by 25 publications

References 30 publications

Telemedicine Screening for Eye Disease

Telemedicine Screening for Eye Disease

Non-Mydriatic Ultra-Widefield Imaging Compared With Single-Field Imaging in the Evaluation of Peripheral Retinal Pathology

Retinal Detachment Associated With AIDS-Related Cytomegalovirus Retinitis: Risk Factors in a Resource-Limited Setting

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