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Jamie Odden, Muriel Schornack, Zhao Bingying, Clara Choo, Saumya M Shah, Gina Stalboerger, Jeffrey Bennett, Cheryl Khanna; Telemedicine in Long-term Care of Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1618. doi: https://doi.org/.
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Application of telemedicine to the care of patients with glaucoma could potentially reduce the frequency with which these patients require in-person care. This study evaluates agreement between in-person and non-visit assessment of glaucoma progression among masked glaucoma providers using data from two consecutive clinic visits.
Fifty adult glaucoma patients seen by a care team (2 glaucoma specialists and 2 optometrists) were enrolled at a single institution at an in-person evaluation with a glaucoma provider. The in-person assessment at time of enrollment was used as the gold standard for defining progression. A masked observer not involved in patient care abstracted all data related to the patient’s glaucoma care from the medical record (demographics, visual acuity, target intraocular pressure (IOP), IOP, cup/disc ratio, medications, surgical history, visual fields, OCT). Collated clinical data were then independently reviewed by four masked providers who classified glaucoma as progression or non-progression in each eye by comparing data from enrollment visit to data from the visit immediately prior to enrollment. Agreement of glaucoma progression between the masked observer and the in-person assessment was determined using Kappa statistics. Intra-observer agreement was calculated using Kappa to compare in-person to non-visit assessment when both assessments were performed by the same provider (n=70 eyes).
One hundred eyes of 50 subjects were analyzed. Agreement between in-person vs. non-visit assessment for the determination of glaucoma progression was 65%, 71%, 72%, and 74% for each reader 1-4 (kappa values = 0.20, 0.33, 0.39, and 0.44 respectively). For intra-observer agreement, reader 2 agreed with her in-person assessment for 67 % of the visits (kappa = 0.24).
Agreement between in-person vs. non-visit assessment of glaucoma progression was fair to moderate for each glaucoma team provider. Intra-observer agreement was similar to the agreement for each provider who did not see the patient in-person. This similarity suggests that telemedicine may be equally effective at identifying glaucomatous disease progression, regardless of whether the same provider performed both in-clinic and non-visit assessments. However, fair to moderate agreement levels highlight the limit of using only tele-medicine data to determine progression compared to clinical detail available during in-patient assessment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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