July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Interphysician Agreement for Screening Images
Author Affiliations & Notes
  • Natasha Nayak Kolomeyer
    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Lisa A Hark
    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
    Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
  • L. Jay Katz
    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Jonathan S. Myers
    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Daniel Lee
    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • M. Reza Razeghinejad
    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Stela Leite
    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Kamran Rahmatnejad
    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Tingting Zhan
    Department of Pharmacology and Experimental Therapeutics, Division of Statistics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Benjamin Leiby
    Department of Pharmacology and Experimental Therapeutics, Division of Statistics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Sarah Hegarty
    Department of Pharmacology and Experimental Therapeutics, Division of Statistics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Paul P Lee
    Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Natasha Kolomeyer, None; Lisa Hark, None; L. Jay Katz, None; Jonathan Myers, None; Daniel Lee, None; M. Reza Razeghinejad, None; Stela Leite, None; Kamran Rahmatnejad, None; Tingting Zhan, None; Benjamin Leiby, None; Sarah Hegarty, None; Paul Lee, None
  • Footnotes
    Support  Supported by the Centers for Disease Control and Prevention
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2737. doi:
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      Natasha Nayak Kolomeyer, Lisa A Hark, L. Jay Katz, Jonathan S. Myers, Daniel Lee, M. Reza Razeghinejad, Stela Leite, Kamran Rahmatnejad, Tingting Zhan, Benjamin Leiby, Sarah Hegarty, Paul P Lee; Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Interphysician Agreement for Screening Images. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2737.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The Philadelphia Telemedicine Glaucoma Detection and Follow-up Study is an innovative, primary care-based eye screening model to detect, treat, and manage glaucoma in high-risk individuals in urban primary care practices (PCP) and federally qualified health centers (FQHC). The purpose of this study was to evaluate the interphysician agreement in the remote interpretation of fundus photographs and clinical data collected during the initial eye screening visit.

Methods : Our targeted, at-risk population included African-Americans, Hispanics and Asians over age 40; adults of any ethnicity over 65 or over age 40 with a family history of glaucoma or diabetes. Participants underwent a free telemedicine eye screening (Visit 1) which included non-mydriatic fundus photography, medical/ocular history, and intraocular pressure measurements in 7 PCPs and 4 FHQCs. A total of 906 subjects’ images were graded as normal, abnormal, or unreadable. 100 subjects were randomly selected for this study sub-analysis. Three glaucoma specialists, who were blinded to the initial grading and follow-up recommendation, participated in this study. Each glaucoma specialist independently graded each eye based on presence of specific glaucomatous optic nerve findings (disc cupping or asymmetry, neuroretinal rim thinning, peripapillary atrophy, nerve fiber layer loss, disc hemorrhage). Based on the photographs of each eye, and clinical information, each grader then selected a suitable follow up-recommendation. The primary outcome of this study was the agreement of the three readers on the follow-up recommendation per subject. Additionally, the number of raters agreeing on follow-up recommendation and glaucoma findings was computed. A consensus diagnosis was defined if at least two of the three raters agreed.

Results : Results of 100 subjects (mean age 57.0 ± 10.2 years): inter-rater reliability for follow-up recommendations was moderate [Fleiss’ kappa = 0.63; 95% CI: (0.56, 0.70)]. All readers agreed on follow-up recommendation for 64% of subjects. Consensus was reached in 96% of subjects, of which 39 were normal, 41 abnormal, and 16 unreadable. With respect to glaucomatous findings, a consensus diagnosis was achieved for all subjects, with 61% agreement among all raters.

Conclusions : There was substantial agreement in interpretation of integrated data and images obtained through a telemedicine screening program.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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