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Bo Li, Anne Marie Powell, Phil Hooper, Thomas G Sheidow; Prospective evaluation of Tele-Ophthalmology in initial screening and recurrence monitoring for wet Age-related Macular Degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2014;55(13):4941.
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To evaluate Tele-Ophthalmology as a tool for screening and monitoring recurrence for wet AMD
Group S: 106 new referral eyes for suspected wet AMD were randomized into routine (IEI-S) or tele-ophthalmology (OHC-S) screening group over a one year period. In the IEI-S group, diagnostic imaging and in-person assessment were performed by retinal consultants at the Ivey Eye Institute (IEI). In the OHC-S group, diagnostic imaging and routine examination were performed at the Ocular Health Centre. OHC-S patients were given evaluation at the IEI if the tele-ophthalmology data from the OHC suggested possible wet AMD. Waiting time between referral, imaging and treatment were calculated. Group M: 63 eyes previously treated for wet AMD at the IEI and without evidence of disease activity were randomized into routine (IEI-M) or tele-ophthalmology monitoring (OHC-M) group. The IEI-M group received regular follow-ups with a retinal consultant with diagnostic imaging at the IEI. The OHC-M group received regular diagnostic imaging and routine examinations at the OHC. OHC-M patients were recalled back to the IEI for treatment if the teleophthalmology data suggested recurrent disease activity. Time for recurrence, treatment initiation and visual acuity were recorded.
The average referral to diagnostic imaging time was 22.5 days for OHC-S and 18.0 days for IEI-S group (P=0.23). The average diagnostic imaging to treatment time was 16.4 days for OHC-S and 11.6 days for the IEI-S group (P=0.11). The overall referral to treatment time was 39.1 days for the OHC-S and 30.4 days for the IEI-S group (P=0.19). The average time for recurrence for the IEI-M was 108.1 days and 103.9 days for the OHC-M group (P=0.85). The average recurrence to treatment time was statistical shorter for the IEI-M group at 0.04 day, compared with 13.6 days for the OHC-M group (P<0.01). The average end-of-study visual acuity was 20/186 for the IEI-M and 20/185 for the OHC-M group (P=0.99).
Tele-Ophthalmology screening for suspected wet AMD does not result in delay of referral to treatment time when compared with retinal consultant based screening. Even though tele-ophthalmology monitoring for wet AMD recurrence resulted in longer wait time for treatment re-initiation, this difference does not result in worse visual outcome.
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