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Karim F Damji, Atsushi Kawaguchi, Noha Sharafeldin, Aishwarya Sundaram, Sandra Campbell, Christopher Rudnisky, Ezekiel Weis, Matthew Tennant; Tele-ophthalmology for age related macular degeneration and diabetic retinopathy: A systematic review and meta analysis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5559.
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© ARVO (1962-2015); The Authors (2016-present)
Recent technological advances combined with the projected rise in chronic eye disease and shortage of ophthalmologists have led to an increased interest in tele-ophthalmology. We conducted an up-to-date systematic review to evaluate the clinical effectiveness of tele-ophthalmology as an alternative to face-to-face patient screening and management for three major chronic eye diseases: age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma.
A search was executed by an expert librarian of the following databases: MEDLINE, EMBASE, EBM Reviews including Cochrane Databases using controlled vocabulary and key words representing "telehealth" and "ophthalmology". We included English language, randomized controlled trials (RCTs) published after 2000 for the analysis. Two reviewers independently assessed quality and extracted data. We used the standard methods of The Cochrane Collaboration to assess methodological quality and risk of bias. For all included trials, bias due to participant knowledge of the allocated intervention was categorized as high risk; however, given the characteristics of the tele-ophthalmology intervention, we assume participant blinding was not feasible.
The search results identified 2,239 unique records and after screening 6 reports of 4 RCTs met the inclusion criteria: 2 trials on AMD and 2 trials on DR. No RCTs were found on glaucoma. Four different outcomes were analyzed: visual outcome, participation in the screening program, referral accuracy, and waiting time to receive referral. Three trials compared detection of choroidal neovascularization (CNV) (n=2146, Odds Ratio (OR): 1.55, 95% Confidence Interval (CI): 1.11 to 2.17). One trial compared tele-ophthalmology using a home monitoring device to standard self-reporting of changes in visual acuity (n=1520, OR: 1.74, 95%CI: 1.09 to 2.76). Two trials on diabetic retinopathy screening reported on participation in the screening program (n=626, OR: 12.99, 95%CI: 7.90 to 21.33).
The review provides evidence of clinical benefits for detection of neovascular AMD and DR screening using tele-ophthalmology. It also demonstrates feasibility of carrying out randomized trials of tele-ophthalmology, albeit with differing modalities for tele-screening. Further research is needed specifically to study clinical effectiveness for glaucoma.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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