Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Unreadable Image Results at Visit 2

Abstract

Purpose : Telemedicine screenings programs across community and office-based settings can be useful in detecting eye pathology. However, unreadable fundus and optic nerve images provide unusable data for diagnosis or evaluation of eye diseases. This study aims to assess the demographic trends, clinical characteristics, and diagnostic results of participants with unreadable images captured during the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study.

Methods : A total of 779 individuals at high-risk for glaucoma were recruited into this study at 7 primary care offices and 4 Federally Qualified Health Centers. Recruitment was targeted at African Americans, Hispanics, and Asians over 40; adults over 65 of any ethnicity; adults over 40 with a family history of glaucoma; or adults over 40 with diabetes. During Visit 1, glaucoma and retina specialists remotely read images, along with visual acuity, intraocular pressure, age/ethnicity, and family history of glaucoma. Individuals with abnormal or unreadable images were invited to return to the same location for a comprehensive eye exam by a glaucoma specialist (Visit 2) within several months. Demographic and clinical data and ocular outcomes of participants with unreadable images at Visit 1 who attended Visit 2 were determined.

Results : From 4/1/15 to 11/4/16, 779 individuals consented and attended Visit 1. Of these, 132 (16.9%) participants had unreadable images. These participants were predominantly female (57.1%) and African American (75.4%), with a mean age of 66.8 +12.7 years (range 42-100). Moreover, 37 participants (52.9%) with unreadable images were older than age 65, and 64 (48.5%) had diabetes. A total of 70 participants with unreadable images attended Visit 2 for a comprehensive eye exam with a glaucoma specialist. Of those, 19 (27.1%) were diagnosed as glaucoma-suspect, 4 (5.7%) had glaucoma, 3 (4.3%) had diabetic retinopathy, 3 (4.3%) had ocular hypertension, 8 (11.4%) had other retinal abnormalities, and 6 (8.6%) had cataracts. The majority of subjects, 52 (74.3%), had other ocular pathologies such as vitreous degeneration, optic atrophy, and disc hemorrhage.

Conclusions : Many participants with unreadable images had eye pathologies that were not detectable with telemedicine. It is therefore useful to conduct a comprehensive eye exam on anyone with unreadable images that have been detected on a telemedicine screening program.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.