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Lindsay Anne Rhodes, Gerald McGwin, Carrie E Huisingh, Cynthia Owsley, Christopher A Girkin; Comparison of the Diagnosis of Glaucoma in a Retail-Based Telemedicine Model. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4266.
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With an expected doubling of the glaucoma patient population by 2020 and with the majority of glaucoma specialists located in urban centers, patients with a glaucoma-associated diagnosis (GAD) may have difficulty accessing a glaucoma specialist. Telemedicine can be used to help bridge this gap. One critical aspect of a successful telemedicine program is establishing a channel of communication between subspecialists and optometrists that will facilitate diagnosis of GAD patients. The purpose of this analysis is to evaluate a fellowship-trained glaucoma specialist’s assessment of a community-based optometrist’s GADs.
Using a demonstration telemedicine program entitled Eye Care Quality and Accessibility Improvement in the Community (EQUALITY), based in two Walmart Vision Center clinics staffed by primary care optometrists (OD), patients were enrolled when they met any of the following at-risk criteria for glaucoma: African Americans or Hispanics ≥ 40 years, whites ≥50 years, persons of any age or race/ethnicity with diabetes, and/or family history of glaucoma; those with a pre-existing diagnosis of glaucoma were also enrolled. Following a comprehensive dilated exam with complete optic nerve head imaging (Cirrus SDOCT, 24-2 SITA perimetry, and stereophotography), the OD recorded a diagnosis and sent the exam and imaging data electronically to the glaucoma specialist (MD), who made an independent diagnosis. The OD and MD diagnoses were then compared.
A total of 352 patients are currently enrolled in the EQUALITY program with a total of 61 patients having a GAD per the OD. The correspondence between the MD and OD was 75%, kappa= 0.57 (95% CI 0.40-0.75) and 67%, kappa= 0.45 (95% CI 0.30-0.63) for the right and left eyes, respectively.
There was moderate agreement between the optometrist and glaucoma specialist for the diagnostic category of GAD. Telemedicine-based approaches may reduce variability in care delivery, particularly for patients who have difficulty accessing face-to-face visits with a subspecialist.
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