Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Diagnostic Positive Predictive Value between Visit 1 and Visit 2

Abstract

Purpose : To assess the effectiveness of a practice-based telemedicine screening program, utilizing fundus photography and optic nerve imaging, medical and ocular history, and intraocular pressure measurements, to improve glaucoma detection.

Methods : Our targeted, at-risk population (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) were offered a free telemedicine eye screening (Visit 1) in 7 primary care offices and 4 Federally Qualified Health Centers in Philadelphia. Participants with abnormal or unreadable images were invited back to the same location for a comprehensive eye exam by a glaucoma specialist (Visit 2). This study evaluated the agreement between the telemedicine screening diagnosis and the confirming eye exam results using positive predictive value.

Results : From 4/1/15 to 11/4/16, 290 participants consented and attended both Visit 1 and Visit 2. Participants were predominately female (60.3%) and African American (72.7%), with a mean age of 59 ±10.6 years (range 39-100). During Visit 1, 306 (47.3%) participants’ images were considered normal. Using image data from the worse eye of the 290 participants diagnosed with abnormal images, 156 (53.8%) were diagnosed with glaucoma suspect at Visit 1; 35 (12.1%) with diabetic retinopathy; and 30 (10.3%) with other retinal abnormalities. Of the 156 diagnosed with glaucoma suspect at Visit 1, 122 were confirmed as glaucoma or glaucoma suspect at Visit 2 (PPV=78.2%) and 21 were confirmed to have glaucoma at Visit 2 (PPV=13.5%). Of the 35 diagnosed with diabetic retinopathy at Visit 1, 21 were confirmed to have diabetic retinopathy at Visit 2 (PPV=60%).

Conclusions : A practice-based telemedicine screening can improve access, detection, and follow-up eye care for individuals at risk for glaucoma and other eye diseases. Given the high positive predictive value of the telemedicine diagnoses of glaucoma suspect and diabetic retinopathy, a glaucoma and retina specialist can accurately and effectively use telemedicine to evaluate fundus photographs and optic nerve images, combined with medical and ocular history, and IOP measurements, to predict glaucoma suspect and other eye pathology.

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