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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)
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.
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.
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).
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
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