September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Telepresence in the diagnosis and management of Glaucoma
Author Affiliations & Notes
  • Nicole Mendez
    Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Bernard C Szirth
    Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Albert S Khouri
    Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Footnotes
    Commercial Relationships   Nicole Mendez, None; Bernard Szirth, None; Albert Khouri, None
  • Footnotes
    Support  NJ Health Foundation
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 853. doi:
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      Nicole Mendez, Bernard C Szirth, Albert S Khouri; Telepresence in the diagnosis and management of Glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):853.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Telepresence allows a remote physician full access to screening data in real time. To determine the accuracy of a novel system for teleglaucoma during community eye screenings and compare outcomes to standard on-site assessment.

Methods : Thirty-four subjects were selected from community outreach screenings conducted according to a predefined, published protocol that included demographics, ocular and systemic history, visual acuity, tonometry, anterior and posterior segment imaging. A Canon CR-2 Plus AF digital, non-mydriatic fundus camera with a resolution of 18 Mp and Fundus Autofluorescence (FAF) capabilities was used. Imaging was conducted in a dimly lit room to prevent inclusion of artifacts. Optic nerve vertical and horizontal cup-to-disc ratio, presence of signs of glaucomatous neuropathy (disc hemorrhage, asymmetry in cup-to-disc ratio, other) were assessed. An analysis software, TeamViewer (Florida, USA) was used for remote access to patient data and images. A glaucoma fellowship-trained physician performed diagnostic and therapeutic recommendations twice on separate days and in a different, random order: remotely by telepresence through TeamViewer in real-time and on-site by physical presence at the screening station. Data regarding the accuracy of diagnostic tests (vertical and horizontal C/D ratio) and follow-up recommendations (<1m, 1-3 month, 1 year follow-up) from telepresence and physical presence were then compared. The Intra-class correlation coefficient (ICC) was used for analysis of measured outcomes.

Results : One hundred and seventeen color and FAF images were assessed (72 fundus color, 34 FAF, 11 anterior segment) from thirty-four subjects presenting as normal (44%), glaucoma suspect (15%), glaucoma (3%), cataract (9%) and other retinal pathology (29%) (mean age 51 +/- 9 yrs, 53% males, 62% Indian, 29% Hispanic, 6% African American and 3% Caucasian) were included in the analysis. A strong ICC (R) between remote and on-site access was found (Table 1).

Conclusions : Telepresence in the diagnosis and management recommendations of glaucoma was successful, accurate and highly correlated with on-site physical presence findings and recommendations. Application of telepresence during screenings in glaucoma and in other vision-threatening diseases, warrants a larger study that can encompass additional imaging technologies such as SD-OCT and OCT-A.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Table 1. Intra-Class Correlation Coefficient between remote and on-site access

Table 1. Intra-Class Correlation Coefficient between remote and on-site access

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