Abstract
Purpose :
The lack of data on how tele-eye care comprehensive eye exams compare to the in-person exams in primary eye care settings prevents law makers from clearly outlining the role of tele-eye care. This randomized clinical trial aims to compare the number of ocular health tests results that are outside of clinical norms, compare the confidence level of the eye care provider (ECP) for each of these tests results and compare the eye health diagnoses (Dx) between hybrid tele-eye care and in-person comprehensive eye exam.
Methods :
Thirty-five optometry-naïve participants (13 M, 22 F, aged 21-58 years), consulting for routine eye examination were randomly subjected to two comprehensive eye exams. The in-person eye exam was completed by an on-site ECP, while the tele-eye care exam was performed by an in-person technician through DigitalOptometricsTM platform and videoconferencing with a remote ECP. All ocular health tests results were categorized according to their compliance to clinical standards and the ECP scored their confidence level for all exam results. Results of the two modalities were compared with Krippendorff's alpha coefficients (a) and Wilcoxon signed rank tests (p). The number of common and different Dx between both modalities were also analyzed.
Results :
No statistically significant difference between both exam modalities was found for all ocular health tests (a> 0.50), apart from extra-ocular motilities (EOM) testing (a= 0.25; *p= 0.025). No abnormal pupils were detected in both modalities. ECP reported significantly better confidence for in-person exams (97 ± 01%) compared to tele-eye care (77 ± 3%) (p< 0.001). Twenty-five Dx were found in tele-eye care compared to 23 in-person, among which 14 (29%) did not match between modalities with eight found only in-person and six found only remotely. These had a low morbidity and included conditions such as mild blepharitis and conjunctivochalasis.
Conclusions :
Our data suggest that for a sample of people consulting for a routine examination, the levels of confidence of ECP are statistically lower for remote eye exams compared to in-person. However, both exam modalities have a statistically equivalent ability to detect out of standards ocular health findings, apart from EOM testing. To better analyze the difference in total number of ocular health Dx, the ECP should have scored a morbidity level to each Dx they made.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.