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Nicole Mendez, Sumana Kommana, Bernard Szirth, Albert S Khouri; Improved retinal imaging and through-put time in Tele-glaucoma versus traditional care: New Jersey Health Foundation prospective clinical trial. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3977.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the effectiveness of remote tele-glaucoma compared to clinical direct observation in retinal imaging and through-put time.
Prospective comparative pilot trial of 30 patients (242 Fundus and 102 Optical Coherence Tomography (OCT) images) screened through the remote tele-glaucoma screening protocol and via the conventional clinical evaluation. Parameters studied included comparisons of through-put (measured as the time from technician review to patient departure), tonometry, ocular examination and particularly optic nerve evaluation (estimation of vertical and horizontal cup-to-disc ratio). Opacity SuppressionTM (OS) software was applied post-capture to enhance image assessment when opacities precluded retina and optic nerve head (ONH) evaluation. Peripapillary and nerve fiber layer (NFL) detail were assessed post-OS on a scale of 1-3 (1=similar, 2=improved, 3=significant improvement) and graded independently by 2 readers. Inter-observer agreement between the two arms (tele-glaucoma and physical presence) were determined.
A strong positive Pearson correlation was observed for a) intraocular pressure of right eye (OD), left eye (OS) (0.92, 0.81) and b) optic nerve cup/disc ratio OD, OS (0.83, 0.87). (Table 1) Although tele-glaucoma had lower accuracy in providing cup/disc ratios (82%) vs. clinical exam (91%), the Opacity Suppression software applied to images improved visualization of peripapillary detail in 70% and 82% of assessed images by grader 1 and 2, respectively. NFL visualization was also improved but to a lesser extent (33% and 50% by grader 1 and 2, respectively). When compared to tele-glaucoma, the conventional clinical exam assessment was 40 minutes longer and required 3 examiners as opposed to a 20-minute through-put in tele-glaucoma and 1 examiner.
Tele-glaucoma provided comprehensive evaluations (tonometry, ocular anterior and posterior segment/optic nerve imaging) that strongly correlated with conventional face-to-face clinical evaluation. Although conventional clinical exam was superior to tele-glaucoma in evaluating the optic nerve C/D ratios, tele-glaucoma proved an efficient mean of patient time and was better with OCT applications for NFL and peripapillary distribution.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Table 1. Pearson Correlation Coefficients of diagnostic exams.
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