Telemedicine using a non-mydriatic color fundus camera for retinal imaging in rural Panama

Abstract

Purpose : The global burden of vision impairment is large, particularly in remote, rural areas with limited access to medical care. Nonprofit medical organizations are staffed mainly by non-ophthalmologic physicians, who have limited training and practice in diagnosis and treatment of retinal disease. Our study aimed to determine if medical students could use a non-mydriatic fundus camera to obtain retinal images with sufficient quality for remote ophthalmologists to read accurately and guide patient care.

Methods : We conducted a retrospective review of a teleophthalmology program implemented at the mobile clinics operated by the Floating Doctors Nonprofit Organization in Bocas del Toro, Panama. Adults presenting to Floating Doctors clinics with ocular complaints or history of diabetes were imaged with the Pictor Plus (Volk) non-mydriatic color fundus camera. Images were graded by two trained graders using a modified version of the FOTO-ED Scale. The scale grades images on a scale of 1-5 based on overall diagnostic utility and the ability to visualize individual components of the retina.

Results : Seventy patients provided a total of 126 images. Average photo quality graded by two ophthalmologists using the modified FOTO-ED scale was 3.30 +/- 0.07. Interrater reliability was 61.42%. Sixty-two out of 126 images (49.2%) were rated at 4 or higher on the FOTO-ED scale. Thirty patients had at least 1 eye rated at Ideal Quality (42.9%), while only 1 patient had no adequate photos taken (1.43%). The most common photo quality was “Not ideal, but able to exclude subtle findings” (4 out of 5 on FOTO-ED scale, 37.07% of grades). For individual components of the posterior segment, the fovea was most reliably imaged, with only 20 (7.85%) total images deemed “unable to grade” by the two graders. The optic nerve cup had the lowest quality of images with 36 (15%) ungradable images.

Conclusions : Imaging of the fovea may be the easiest for minimally trained students, while imaging the optic nerve cup accurately was the most difficult. Mydriasis is likely to increase imaging facility. These findings suggest that with minimal training, medical students and general practitioners can use remote retinal cameras such as the Pictor Plus to assist with diagnosis and treatment of posterior segment pathology in low resource settings, such as in Bocas del Toro, Panama.

This is a 2020 ARVO Annual Meeting abstract.