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A. H. Skalet, S. Ausayakhun, S. Ausayakhun, C. Jirawison, J. D. Keenan, C. Khouri, D. Heiden, G. N. Holland, T. P. Margolis; Telemedicine for Cytomegalovirus (CMV) Retinitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4851.
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CMV retinitis is a treatable infection of the retina in patients with AIDS. It is a leading cause of blindness in areas of the world most affected by the AIDS epidemic. Early recognition of CMV retinitis is key to saving vision, but ophthalmologists trained for this purpose are often in short supply in the hardest hit areas. In this study we describe the results of a study of a telemedicine system for identification of CMV retinitis,
In a cross-sectional study, 94 consecutive patients with HIV (188 eyes) seen in 2008-09 at Chiang Mai University (CMU) were photographed using a Topcon NW6S retinal camera during their initial visit. Images were uploaded to the internet for remote grading by three expert readers in the United States. Results of remote grading were then compared to on-site exam of patients by local ophthalmologists. The sensitivity, specificity, and intra- and inter-grader reliability were then calculated.
Ophthalmologists at CMU diagnosed 59 of the 94 patients (63%) with CMV retinitis in at least one eye. They were able to definitively determine whether CMV retinitis was present or absent in 181 of the 188 eyes (96%). The remaining 7 eyes were graded as "can not determine" and excluded from analyses. 100% of the images from the remaining 181 eyes were successfully transferred to the internet using existing infrastructure. Remote graders determined that 80-92.8% of the mosaic images were gradeable (satisfactory or good quality). As compared to the on-site exams in Thailand,the sensitivity for detecting CMV retinitis by remote readers ranged from 89-91%. Specificity ranged from 85-88%. Intra-rater reliability was high, with kappas for each grader ranging from 0.93 to 0.96. Inter-rater reliability among the three graders was also high; unweighted kappa=0.85.
Remote diagnosis by telemedicine can be a sensitive and specific method for diagnosing CMV retinitis among HIV patients.
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