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Ryan Sameen Meshkin, Grayson W Armstrong, Nathan Hall, Alice Carlyle Lorch; Effectiveness of a Telemedicine Program for Diagnosis and Triage of Common Ophthalmic Chief Complaints. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2651.
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The growing need for cost-effective, accessible ophthalmic care has led to an interest in telemedicine. The capabilities of telemedicine for diagnosis and triage of emergent eye complaints warrants investigation. This study assesses the utility of a tele-ophthalmology program to diagnose and triage common ophthalmic complaints presenting to an ophthalmic emergency room.
Prospective, observational study of 258 eyes of 129 patients presenting to the Massachusetts Eye and Ear Infirmary Emergency Ward (MEE EW) completed a questionnaire to gather chief complaint, history of present illness, and medical history. Anterior segment photographs with and without fluorescein dye were collected via iPhone 5C camera and posterior segment photos by a Canon non-mydriatic fundus camera. Ophthalmic vital signs were collected by MEE EW physicians. All information was reviewed remotely by three MEE physicians; a diagnosis and urgency designation was recorded. Remote findings were compared to in-person clinical findings, which were treated as the gold standard. Primary outcomes included sensitivity and specificity of triage status and diagnostic accuracy via virtual examination of patients with common ophthalmic complaints: eye pain, eye redness, blurry vision, eyelid complaint. The study was not powered for subgroup analysis.
129 patients were recruited, of which 69 (53.50%) were female with mean age 56 (range 23-96). Sensitivities and specificities for telemedical triage were as follows: eye pain (n=56; sens: 0.58, CI [0.41, 0.74]; spec: 0.91, CI [0.80, 1]), eye redness (n=54; 0.68, CI [0.50, 0.86]; 0.93, CI [0.84, 1]), blurry vision (n=68; 0.73, CI [0.60, 0.86]; 0.91, CI [0.80, 1]), and eyelid complaints (n=42; 0.67, CI [0.43, 0.91]; 0.96, CI [0.89, 1]). The remote diagnostic accuracies, as stratified by chief complaint, were eye pain (27/56; 48.21%), eye redness: (32/54; 59.26%), blurry vision: (30/68; 44.11%), eyelid (24/42; 57.14%).
Telemedical examination of emergent ophthalmic complaints consisting of a patient questionnaire, anterior segment and fundus photos, and ophthalmic vital signs, may be able to reliably triage eye disease based on presenting complaint. Further research is needed to evaluate the diagnostic accuracy of ophthalmic telemedicine for specific ophthalmic conditions in larger pilot studies of patients with emergent eye complaints.
This is a 2021 ARVO Annual Meeting abstract.
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