Abstract
Purpose :
The standard-of-care for the evaluation of donor corneas with concerning examination findings is an in-person medical director consult. Such consults can prolong the death-to-use time and are burdensome to both the eye bank and examining medical director. We performed a prospective comparison of an in-person tissue evaluation by a medical director versus a telemedicine evaluation of donor corneas to determine transplant suitability.
Methods :
During tissue evaluation, eye bank technicians identified pathology on donor corneas which necessitated a medical director consultation. Digital images of the pathology were collected with imaging techniques appropriate for the type of pathology, including slit lamp photography, anterior segment optical coherence tomography, and specular microscopy. Images and clinical history of each donor were then electronically sent to three medical directors of the eye bank for a telemedicine evaluation. Medical directors were asked to assess whether the tissue was safe for transplantation and if the tissue was suitable for endothelial keratoplasty (EK), anterior keratoplasty (AK), or penetrating keratoplasty (PK). These responses were compared to an in-person evaluation by a medical director for the final determination.
Results :
Eleven donor corneas required medical director consultation to evaluate corneal pathologies. In 5 out of the 11 consults, all telemedicine evaluators agreed with the in-person evaluator regarding whether or not the tissue was safe for corneal transplantation. Of the remaining 6 consults, 4 of them attained agreement among 3 out of 4 of the evaluators, and 2 of them attained no consensus (i.e. a 50/50 split between the evaluators). Regarding the type of corneal transplantation that tissue was suitable for, only 3 out of the 11 consults attained agreement among all 4 evaluators, with mixed agreement of the remaining 8 consults.
Conclusions :
Telemedicine consults had a high ability for detecting corneal tissue that was safe for transplantation, but there was interobserver disagreement with regard to making specific determinations of transplant suitability for AK, EK, or PK. Such disagreement may reflect shortcomings in the study’s telemedicine protocol and/or the subjective nature of such decisions.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.