Telemedicine Screening for Cytomegalovirus Retinitis Using Digital Fundus Photography

Shah, Jinesh M.; Leo, Serene; Pan, James C.; Yong, Vernon K.; Wong, Elizabeth; Lim, Tock Han; Teoh, Stephen C.

doi:10.1089/tmj.2012.0233

Cited by 14 publications

(5 citation statements)

References 13 publications

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“…This latter and ours have in common having performed the examination under dilation and in a young population with average age of 38 y 32 years old respectively, which would explain the high values in both studies, and the lower percentage of non-assessable images due to media opacity. On the other hand, Sha et al 23 found values very similar to ours in dilated patients using a Kodak DCS620 digital-back camera, with photos in nine fields, reaching a 100% sensitivity and 99% of specificity.…”

Section: Discussionsupporting

confidence: 83%

Study to evaluate efficacy of midriatic-digital-images when screening retinal-complications in people living with HIV

et al. 2022

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To determine efficacy of mydriatic-digital images (MDI) when screening retinal complications in people living with HIV, in this study, a consecutive series of 79 people living with HIV (PLHIV) were evaluated. Two series of MDI were taken: - macula and optic nerve - nine gaze fields, which findings were compared with those obtained by a retina specialist. Both examiners were unaware of each other’s results. Average age was 32.2 years old, predominantly male (75.9%). Most frequent complications were HIV retina microangiopathies (6.3%) and toxoplasmosis (5.1%), followed by Cytomegalovirus and neuro-retinitis, optic neuritis and vitreitis, each one with 1.3%. Sensitivity with two MDI was 92.8% (CI 95% 66.0–100.0) and with nine 100% (CI 95% 77.0–100.0) and specificity of 95.4% (CI 95% 87.0–99.0) for both series. The positive predictive value was 81.3 and 82.4%, and negative predictive value was 98.4 and 100% respectively. The strength of agreement was substantial for the two series with the retina specialist examination (Kappa index of 0.836 and 0.888 respectively). Mydriatic-digital-images appear to be an effective method to screen for HIV-related retinal-complications in a regional hospital in Perú.

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Section: Discussionsupporting

confidence: 83%

Study to evaluate efficacy of midriatic-digital-images when screening retinal-complications in people living with HIV

et al. 2022

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“…[41–44] While these studies demonstrate the validity and utility of a telemedicine platform for DR screening, they either use bulky, expensive, or time consuming (e.g., requiring pupillary dilation) cameras. These camera systems are not reasonable to use in many rural, low-resource settings, where resources, staff, and infrastructure are limited.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy

et al. 2017

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Purpose: To analyze predictors of image quality for a handheld nonmydriatic fundus camera used for screening of vision-threatening diabetic retinopathy. Methods: An ophthalmic photographer at an Aravind Eye Hospital obtained nonmydriatic and mydriatic fundus images from 3 fields in 275 eyes of 155 participants over 13 months using a Smartscope camera (Optomed, Oulu, Finland) and a Topcon tabletop fundus camera (Topcon, Tokyo, Japan). Two fellowship-trained retina specialists graded the images. Repeated-measures logistic regression assessed predictors of the main outcome measure: gradability of the fundus images. Results: Of 2,475 images, 76.2% of the Smartscope nonmydriatic images, 90.1% of the Smartscope mydriatic images, and 92.0% of the Topcon mydriatic images were gradable. Eyes with vitreous hemorrhage (OR = 0.24, p < 0.0001) or advanced cataract (OR = 0.08, p < 0.0001) had decreased odds of image gradability. Excluding eyes with cataract or vitreous hemorrhage, nonmydriatic macular image gradability improved from 68.4% in the first set of 55 eyes to 94.6% in the final set of 55 eyes. Conclusion: With sufficient training, paraprofessional health care staff can obtain high-quality images with a portable nonmydriatic fundus camera, particularly in patients with clear lenses and clear ocular media.

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“…Retinal imaging is frequently used in disease diagnosis and monitoring such as diabetic retinopathy (DR), glaucoma and age-related macular degeneration (AMD), Retinopathy of Prematurity (ROP) 5 and systemic diseases such as hypertension 6 , malaria 7, HIV/AIDS 8 and syphilis 9…”

Section: Introductionmentioning

confidence: 99%

Clinical Validation of a Smartphone-Based Adapter for Optic Disc Imaging in Kenya

et al. 2016

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Importance Visualization and interpretation of the optic nerve and retina is an essential part of most physical examinations. Objectives To design and validate a smartphone-based retinal adapter enabling image capture and remote grading of the retina Design, setting and participants Validation study comparing the grading of optic nerves from smartphones images with those of a Digital Fundus Camera. Both image sets were independently graded at Moorfields Eye Hospital Reading Centre. Nested within the six-year follow-up of the Nakuru Eye Disease Cohort in Kenya: 1,460adults (2,920eyes) aged 55years and above were recruited consecutively from the Study. A sub-set of 100 optic disc images from both methods were further used to validate a grading app for the optic nerves. Main outcome(s) and measure(s) Vertical cup-to-disc-ratio (VCDR) for each test was compared, in terms of agreement (Bland-Altman & weighted Kappa) and test-retest variability (TRV). Results 2,152 optic nerve images were available from both methods (additionally 371 from reference but not Peek, 170 from Peek but not the reference and 227 from neither the reference camera or Peek). Bland-Altman analysis demonstrated a difference of the average of 0.02 with 95% limits of agreement between -0.21 and 0.17 and a weighted Kappa coefficient of 0.69 (excellent agreement). An experienced retinal photographer was compared to a lay photographer (no health care experience prior to the study) with no observable difference in image acquisition quality between them. Conclusions and relevance Non-clinical photographers using the low-cost Peek Retina adapter and smartphone were able to acquire optic nerve images at a standard that enabled comparable independent remote grading of the images to those acquired using a desktop retinal camera operated by an ophthalmic assistant. The potential for task-shifting and the detection of avoidable causes of blindness in the most at risk communities makes this an attractive public health intervention.

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Telemedicine Screening for Cytomegalovirus Retinitis Using Digital Fundus Photography

Abstract: DFP is a sensitive and specific method of screening HIV patients for CMVR and has a high level of agreement with indirect ophthalmoscopy.

Cited by 14 publications

References 13 publications

Study to evaluate efficacy of midriatic-digital-images when screening retinal-complications in people living with HIV

Study to evaluate efficacy of midriatic-digital-images when screening retinal-complications in people living with HIV

Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy

Clinical Validation of a Smartphone-Based Adapter for Optic Disc Imaging in Kenya

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