June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Comparison of the diagnosis of glaucoma by in-person ophthalmologist, optometrist, and telemedicine
Author Affiliations & Notes
  • Poojitha Balakrishnan
    University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Cynthia Owsley
    University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Christopher A Girkin
    University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Lindsay Anne Rhodes
    University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Footnotes
    Commercial Relationships   Poojitha Balakrishnan, None; Cynthia Owsley, None; Christopher Girkin, None; Lindsay Rhodes, None
  • Footnotes
    Support  NEI 1K23EY025724-01A1
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 53. doi:
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      Poojitha Balakrishnan, Cynthia Owsley, Christopher A Girkin, Lindsay Anne Rhodes; Comparison of the diagnosis of glaucoma by in-person ophthalmologist, optometrist, and telemedicine. Invest. Ophthalmol. Vis. Sci. 2020;61(7):53.

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

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Abstract

Purpose : With an expected 74% increase of the glaucoma population by 2040 and with the majority of glaucoma specialists located in urban centers, glaucoma patients may have difficulty accessing a glaucoma specialist in person. Telemedicine can be used to increase accessibility by providing ophthalmologist review of patient data collected remotely by an optometrist or by a screening program. A comparison is needed to assess the agreement of an optometrist’s diagnosis and a telemedicine diagnosis with the “gold standard” diagnosis made by an ophthalmologist’s exam in-person. This study compared the level of diagnostic agreement between three types of optic nerve evaluations: in-person ophthalmologist (MD), in-person optometrist (OD), and telemedicine (TMD).

Methods : Patients presenting to an academic tertiary referral glaucoma clinic were independently examined for glaucoma with a dilated exam and structural and functional optic nerve testing by both an MD and OD. Structural and functional optic nerve testing (visual field, optical coherence tomography, and photos) was then reviewed by two ophthalmologists (TMD1 and TMD2) with blinding as to the MD and OD diagnoses. Agreement between each method of diagnosis (MD, OD, and TMD1 and TMD2) of normal vs. disease (open angle glaucoma, normal tension glaucoma, other type of glaucoma, other type of optic nerve, ocular hypertension, glaucoma suspect) for each eye was calculated using Cohen’s unweighted Kappa statistic.

Results : Of 100 patients enrolled, 50% had a normal diagnosis by the MD. There was moderate agreement between the MD and two TMD’s (TMD1: Kappa=0.48 [95% CI 0.36-0.60], TMD2: kappa=0.53 [95% CI 0.41-0.65]), and between the two ophthalmologists using telemedicine (TMD1 vs. TMD2 kappa=0.57 [95% CI 0.46-0.68]). The agreement between MD and OD was fair (kappa=0.40 [95% CI 0.27-0.53]).

Conclusions : Telemedicine provides an innovative and moderately accurate method for glaucoma detection, particularly for patients who have difficulty accessing face-to-face visits with a subspecialist, such as in rural or underserved settings. Telemedicine performed more accurately than optometrist in terms of agreement with the gold standard in-person ophthalmologist exam.

This is a 2020 ARVO Annual Meeting abstract.

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