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Aiello LP, Jacoba CMP, Ashraf M, Cavallerano JD, Tolson AM, Tolls D, Sun JK, Silva PS. INTEGRATING MACULAR OPTICAL COHERENCE TOMOGRAPHY WITH ULTRAWIDE-FIELD IMAGING IN A DIABETIC RETINOPATHY TELEMEDICINE PROGRAM USING A SINGLE DEVICE. Retina 2023; 43:1928-1935. [PMID: 37871272 DOI: 10.1097/iae.0000000000003883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE To determine the effect of combined macular spectral-domain optical coherence tomography (SD-OCT) and ultrawide field retinal imaging (UWFI) within a telemedicine program. METHODS Comparative cohort study of consecutive patients with both UWFI and SD-OCT. Ultrawide field retinal imaging and SD-OOCT were independently evaluated for diabetic macular edema (DME) and nondiabetic macular abnormality. Sensitivity and specificity were calculated with SD-OCT as the gold standard. RESULTS Four hundred twenty-two eyes from 211 diabetic patients were evaluated. Diabetic macular edema severity by UWFI was as follows: no DME 93.4%, noncenter involved DME (nonciDME) 5.1%, ciDME 0.7%, ungradable DME 0.7%. SD-OCT was ungradable in 0.5%. Macular abnormality was identified in 34 (8.1%) eyes by UWFI and in 44 (10.4%) eyes by SD-OCT. Diabetic macular edema represented only 38.6% of referable macular abnormality identified by SD-OCT imaging. Sensitivity/specificity of UWFI compared with SD-OCT was 59%/96% for DME and 33%/99% for ciDME. Sensitivity/specificity of UWFI compared with SDOCT was 3%/98% for epiretinal membrane. CONCLUSION Addition of SD-OCT increased the identification of macular abnormality by 29.4%. More than 58.3% of the eyes believed to have any DME on UWF imaging alone were false-positives by SD-OCT. The integration of SD-OCT with UWFI markedly increased detection and reduced false-positive assessments of DME and macular abnormality in a teleophthalmology program.
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Affiliation(s)
- Lloyd Paul Aiello
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | | | - Mohamed Ashraf
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jerry D Cavallerano
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ann M Tolson
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
| | - Dorothy Tolls
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
| | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Paolo S Silva
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Pradeep R, Amalnath SD, Kasturi N. Smartphone fundus photography by a physician in medical emergencies: An analytical cross-sectional study of 182 patients. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:291-294. [PMID: 38759976 DOI: 10.25259/nmji_208_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Background Fundus examination is an integral part of the clinical evaluation of patients with medical emergencies. It is done at the bedside using a portable direct ophthalmoscope. Smartphone fundus photography (SFP) is a novel technique of retinal imaging. We evaluated the use of SFP by a physician in medical emergencies and compared it with direct ophthalmoscopy (DO) findings of the ophthalmologist. Methods We did a prospective study on patients admitted with medical emergencies with an indication for fundus examination. The SFP was done by the physician, and its findings were noted. These were compared with the DO findings of the ophthalmologist. Results Of the 182 patients studied, 111 (61%) had fundus findings by SFP and 95 (52.5%) by DO. Papilloedema (21.4%), haemorrhages (20%) and Roth spots (12.5%) were most common. DO missed early papilloedema and findings in the peripheral retina. Conclusions SFP is as effective as DO, in detecting retinal findings in patients with medical emergencies and can be performed at the bedside by the physician.
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Affiliation(s)
- R Pradeep
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - S Deepak Amalnath
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Lin CJ, Hsu AY, Tien PT, Chang CH, Lai CT, Hsia NY, Yang YC, Bair H, Chen HS, Chen WL, Tsai YY. Diabetic retinopathy as a potential risk factor for ptosis: A 13-year nationwide population-based cohort study in Taiwan. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1093064. [PMID: 38455898 PMCID: PMC10910925 DOI: 10.3389/fepid.2023.1093064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2024]
Abstract
Purpose To determine the risk of ptosis among diabetic retinopathy (DR) patients. Methods This is a population-based, retrospective, matched-cohort study where DR patients were recruited from the Taiwan National Health Insurance Research Database (NHIRD) to investigate the risk of developing ptosis. Preexisting co-factors of interest included smoking status and medical comorbidities of hyperlipidemia and hypertension. Statistical analysis was performed using T-test, Cox-proportional hazard ratios adjusted for comorbidities (aHR), Wilcoxon rank sum test, Kaplan-Meier estimators, and log rank tests. Results Follow-up data of 9,494 patients with DR and 37,976 matched control cohort (non-DR) from 2000 to 2012 were analyzed. DR patients were found to have significantly increased risk of developing ptosis (adjusted hazard ratio (HR) [95% CI]: 2.76 [1.74-4.38], p < 0.001) when compared to the control cohort. From analysis in different strata, adult age and non-smokers were shown to have higher risk for ptosis development among DR patients. Furthermore, DR patients was also found to have increased risk of developing ptosis when compared to matched controls, regardless of whether they had medical comorbidities of lipid metabolism disorders or hypertension. Conclusions In this large-scale study using real-world data, our results showed that DR patients were found to have increased risk of developing ptosis. Female gender, adult age, and non-smokers were also shown to increase the risk of ptosis among DR patients. This has implications towards the care of diabetic patients, complications such as ptosis should be properly screened for when encountering such patients. Before ptosis surgery, the possibility of underlying diabetes or DR should be also scrutinized and treated properly to avoid undesirable postoperative dissension.
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Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Alan Y. Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Changhua Hospital, Changhua, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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Wong JKW, Zhu MM, Lam JCH, Leung KMK, Lian JX, Lam CLK, Shih KC, Lai JSM. Prospective Comparative Study Investigating Agreement between Tele-Ophthalmology and Face-to-face Consultations in Patients Presenting with Chronic Visual Loss. Ophthalmol Ther 2022; 11:1199-1213. [PMID: 35416584 PMCID: PMC9006210 DOI: 10.1007/s40123-022-00506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/28/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction This study aims to investigate the diagnostic accuracy of store-and-forward tele-ophthalmology consultations for non-diabetic patients, aged 40 and above, presenting with vision impairment of 3 months or more, in terms of cataracts, glaucoma, and age-related macular degeneration. Methods This is a prospective comparative study. Enrolled subjects were independently assessed by both tele-ophthalmology and face-to-face assessment. Agreement level between the two modalities for diagnosis and severity were compared using kappa statistic. Diagnostic accuracy of tele-ophthalmology was determined using the face-to-face consultation serving as the gold standard. Costs were compared by calculating the downstream costs generated by each modality in terms of investigations and treatment. Results A total of 860 eyes of 430 patients were assessed during the study period. Tele-ophthalmology consultations had significantly high agreement with face-to-face consultations in the diagnosis and grading of all three ocular conditions; cataracts, glaucoma, and AMD. Diagnosis and grading of cataracts and AMD reached \documentclass[12pt]{minimal}
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\begin{document}$$\kappa$$\end{document}κ values between 0.61 and 0.8. In terms of diagnostic accuracy, tele-ophthalmology consultations were highly sensitive and specific for AMD with greater than 99% sensitivity and specificity achieved by tele-ophthalmology. There was high specificity when diagnosing cataracts, but lower sensitivity at 87.8%. Conversely, there was high sensitivity for diagnosing glaucoma, but lower specificity at 76.5%. Downstream costs were similar between groups. Conclusions Store-and-forward tele-ophthalmology consultations are accurate and comparable to face-to-face consultations for diagnosis and grading of cataracts, glaucoma, and AMD. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00506-x.
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Affiliation(s)
- Jasper Ka-Wai Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR
| | - Ming Ming Zhu
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR
| | - Jason Chi-Hang Lam
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR
| | - Keith Man-Kei Leung
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR
| | - Jin Xiao Lian
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong SAR
| | - Cindy Lo-Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong SAR, Hong Kong SAR, Hong Kong SAR
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR.
| | - Jimmy Shiu-Ming Lai
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR.
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Aljefri S, Al Adel F. The validity of diabetic retinopathy screening using nonmydriatic fundus camera and optical coherence tomography in comparison to clinical examination. Saudi J Ophthalmol 2021; 34:266-272. [PMID: 34527870 PMCID: PMC8409362 DOI: 10.4103/1319-4534.322617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE: To evaluate the use of non-mydriatic fundus camera as a screening modality for diabetic retinopathy in a sample of population in Riyadh, Saudi Arabia. METHODS: Patients coming, from April 2015 till September 2018, for their diabetic check up at the diabetic center clinics in King Abdul-Aziz University hospital were screened using a non-mydriatic fundus camera (NMFC). Photos were graded by retina specialist and compared to the findings of dilated fundus examination (DFE) by retina specialists. RESULTS: The grading results of NMFC and DFE were compared and the overall sensitivity and specificity for detection of diabetic retinopathy within one grade of retinopathy was 98.7% and 80% respectively. The sensitivity for detection of sight threatening conditions such as proliferative diabetic retinopathy, severe non-proliferative diabetic retinopathy, and diabetic macular edema (by Ocular Coherence Tomography) was found to be 86.7%, 90.3% and 100% respectively; while the specificity was found to be 96.5%, 93%, and 100% respectively. CONCLUSION: Non-mydriatic fundus camera has a high sensitivity and specificity in screening for diabetic retinopathy. It is a great screening tool, which is user friendly and can be operated by trained nurses in primary clinics during patient's regular routine diabetic checkups. It aids in early detection of sight threatening conditions which need urgent referral to ophthalmologists.
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Affiliation(s)
- Sarah Aljefri
- Department of Ophthalmology, College of Medicine, Imam Muhammad Bin Saud Islamic University, Riyadh, Saudi Arabia
| | - Fadwa Al Adel
- Assistant Professor College of Medicine, Ophthalmology Department, Princess Nourah bint Abdulrahman University, Saudi Arabia
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Fonda SJ, Bursell SE, Lewis DG, Clary D, Shahon D, Horton MB. The Indian Health Service Primary Care-Based Teleophthalmology Program for Diabetic Eye Disease Surveillance and Management. Telemed J E Health 2020; 26:1466-1474. [PMID: 32004436 PMCID: PMC7757525 DOI: 10.1089/tmj.2019.0281] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Historically, fewer than half of American Indians and Alaska Natives (AI/AN) with diabetes received the annual diabetic retinopathy (DR) examination that is considered the minimum standard of care; this rate is similar to that of the general United States (U.S.) population with diabetes. Solution: The Indian Health Service-Joslin Vision Network (IHS-JVN) Teleophthalmology Program in 2000 to increase compliance with DR standards of care among AI/AN through validated, primary care-based telemedicine. The IHS-JVN provides remote diagnosis of DR severity, with a report including management recommendations that is returned to the patient's primary care provider. The program conforms with the American Telemedicine Association (ATA) Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy. Outcomes: The IHS-JVN has been expanding incrementally since the first patients were recruited in 2000; this expansion coincides with large improvements in the annual DR examination rates reported as part of local, regional, and national regulatory compliance under the Government Performance and Results Act (GPRA). Currently, with 99 clinical implementations in 23 states, IHS-JVN is the largest primary care-based ATA validation category three telemedicine program in the U.S. Summary: This article describes the program's workflow, imaging and reading technologies, diagnostic protocols, reports to providers, training, quality assurance processes, and geographical distribution. In addition to its clinical use, the program has been utilized in research on utilization of diabetic eye care, cost-effectiveness, technology development, and DR epidemiology of the AI/AN population. Potential next steps for this program are discussed.
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Affiliation(s)
| | - Sven-Erik Bursell
- Telehealth Research Institute, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Drew G. Lewis
- Estenda Solutions, Inc., Conshohocken, Pennsylvania, USA
| | - Dawn Clary
- Indian Health Service-Joslin Vision Network, Phoenix Indian Medical Center, Phoenix, Arizona, USA
| | - Dara Shahon
- Indian Health Service-Joslin Vision Network, Phoenix Indian Medical Center, Phoenix, Arizona, USA
- Department of Ophthalmology, Phoenix Indian Medical Center, Phoenix, Arizona, USA
| | - Mark B. Horton
- Indian Health Service, Phoenix Indian Medical Center, Phoenix, Arizona, USA
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Mohamad Shahimin M, Razali A. An Eye Tracking Analysis on Diagnostic Performance of Digital Fundus Photography Images between Ophthalmologists and Optometrists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010030. [PMID: 31861457 PMCID: PMC6982190 DOI: 10.3390/ijerph17010030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022]
Abstract
To investigate the parameters of eye movement between ophthalmologists and optometrists while diagnosing digital fundus photographs, sixteen participants (eight ophthalmologists and eight optometrists) were recruited in this study. Every participant’s eye movement during diagnosis of a randomized set of fundus photographs displayed on an eye tracker were recorded. Fixation metrics (duration, count and rate) and scan path patterns were extracted from the eye tracker. These parameters of eye movement and correct diagnosis score were compared between both groups. Correlation analyses between fixation metrics and correct diagnosis score were also performed. Although fixation metrics between ophthalmologists and optometrists were not statistically different (p > 0.05), these parameters were statistically different when compared between different area of interests. Both participant groups had a similar correct diagnosis score. No correlation was found between fixation metrics and correct diagnosis score between both groups, except for total fixation duration and ophthalmologists’ diagnosis score of diabetic retinopathy photographs. The ophthalmologists’ scan paths were simpler, with larger saccades, and were distributed at the middle region of the photographs. Conversely, optometrists’ scan paths were extensive, with shorter saccades covering wider fundus areas, and were accumulated in some unrelated fundus areas. These findings indicated comparable efficiency and systematic visual search patterns between both the groups. Understanding visual search strategy could expedite the creation of a novel training routine for interpretation of ophthalmic diagnostic imaging.
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Affiliation(s)
- Mizhanim Mohamad Shahimin
- Optometry & Vision Sciences Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Correspondence:
| | - Azalia Razali
- Ophthalmology Department, Hospital Selayang, Lebuhraya Selayang-Kepong, Batu Caves, Selangor 68100, Malaysia;
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Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Analysis of Unreadable Fundus Images. J Glaucoma 2019; 27:999-1008. [PMID: 30180021 DOI: 10.1097/ijg.0000000000001082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to ascertain determinants of unreadable fundus images for participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. METHODS Individuals were screened for glaucoma at 7 primary care practices and 4 Federally Qualified Health Centers using telemedicine. Screening (visit 1) included fundus photography, assessing family history of glaucoma, and intraocular pressure (IOP) measurements. Participants with an unreadable image in at least one eye were deemed unreadable and invited to return for a confirmatory eye examination (visit 2). RESULTS A total of 906 participants completed the visit 1 eye screening and 17.1% (n=155/906) were "unreadable." In the multivariable logistic regression analysis, older age, male sex, smoking, and worse visual acuity were significantly associated with an unreadable fundus image finding at the eye screening (P<0.05). Of the 89 participants who were invited for the confirmatory eye examination solely for unreadable images and attended visit 2, 58 (65.2%) were diagnosed with at least one ocular pathology. The most frequent diagnoses were cataracts (n=71; 15 visually significant, 56 nonvisually significant), glaucoma suspects (n=27), and anatomical narrow angle (n=10). CONCLUSIONS Understanding the causes of unreadable fundus images will foster improvements in telemedicine techniques to optimize the predictive accuracy, efficiency, and cost in ophthalmology. A high proportion of participants with unreadable images (65.2%) in our study were diagnosed with some ocular pathology, indicating that the finding of an unreadable fundus image warrants a referral for a comprehensive follow-up eye examination.
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Deep learning based computer-aided diagnosis systems for diabetic retinopathy: A survey. Artif Intell Med 2019; 99:101701. [DOI: 10.1016/j.artmed.2019.07.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/19/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023]
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Liu Y, Rajamanickam VP, Parikh RS, Loomis SJ, Kloek CE, Kim LA, Hitchmoth DL, Song BJ, Xerras DC, Pasquale LR. Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program. Telemed J E Health 2018; 25:301-308. [PMID: 30040526 PMCID: PMC6482899 DOI: 10.1089/tmj.2018.0019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background:Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability. Introduction:We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program. Methods:Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (Ppos) or negative agreement (Pneg) were used to assess variability. Results:Among cases deemed gradable by all three readers (n = 65), there was substantial agreement on absence of any retinopathy (88% ± 4.6%, Pneg = 0.91–0.95), presence of moderate nonproliferative or worse retinopathy (87% ± 3.9%, Ppos = 0.67–1.00), and presence of macular edema (99% ± 0.9%, Ppos = 0.67–1.00). There was limited agreement regarding presence of referable nondiabetic eye pathology (61% ± 11%, Ppos = 0.21–0.59) and early, nonroutine referral for a follow-up clinical eye exam (66% ± 8.1%, Ppos = 0.19–0.54). Among all cases (n = 100), there was acceptable agreement regarding which had gradable images (77% ± 5.0%, Ppos = 0.50–0.90). Discussion:Inclusion of multiple types of eye care providers as teleophthalmology readers is unlikely to produce significant variability in the assessment of diabetic retinopathy among high-quality images. Greater variability was found regarding image gradability, nondiabetic eye pathology, and recommended clinical referral times. Conclusions:Our results suggest that more extensive training and uniform referral standards are needed to improve consensus on image gradability, referable nondiabetic eye pathology, and recommended clinical referral times.
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Affiliation(s)
- Yao Liu
- 1 Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Victoria P Rajamanickam
- 2 Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Ravi S Parikh
- 3 Department of Ophthalmology and Visual Science, Yale School of Medicine , New Haven, Connecticut
| | - Stephanie J Loomis
- 4 Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, Massachusetts
| | - Carolyn E Kloek
- 4 Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, Massachusetts
| | - Leo A Kim
- 4 Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, Massachusetts
| | - Dorothy L Hitchmoth
- 5 White River Junction Veteran's Affairs Medical Center , Veteran's Health Administration, White River Junction, Vermont
| | - Brian J Song
- 4 Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, Massachusetts
| | - Dean C Xerras
- 6 Harvard Medical School, Massachusetts General Hospital Chelsea HealthCare Center , Boston, Massachusetts
| | - Louis R Pasquale
- 4 Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, Massachusetts.,7 Channing Division of Network Medicine, Brigham and Women's Hospital , Boston, Massachusetts
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Woodward MA, Musch DC, Hood CT, Greene JB, Niziol LM, Jeganathan VSE, Lee PP. Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability. Cornea 2017; 36:1159-1165. [PMID: 28820791 PMCID: PMC5646384 DOI: 10.1097/ico.0000000000001294] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Corneal and anterior segment diseases cause most of the urgent visits to eye care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from 2 portable cameras for telemedicine purposes. METHODS This is a prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A cornea specialist provided the gold standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for the presence of pathology. Accuracy to detect disease was compared with gold standard diagnosis, stratified by the camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal). RESULTS A total of 198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54% to 71% for the iTouch and 66% to 75% for the Nidek, across graders; specificity ranged from 82% to 96% for the iTouch and 91% to 98% for the Nidek. The intergrader reliability was moderate to strong (kappa ranges: 0.54-0.71 for the iTouch; 0.75-0.76 for the Nidek). Quality ratings were variable between graders. CONCLUSIONS External photographs taken by standard, nonenhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.
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Affiliation(s)
- Maria A Woodward
- *Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and ‡Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
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Davila JR, Sengupta SS, Niziol LM, Sindal MD, Besirli CG, Upadhyaya S, Woodward MA, Venkatesh R, Robin AL, Grubbs J, Newman-Casey PA. Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy. Ophthalmologica 2017; 238:89-99. [PMID: 28675903 DOI: 10.1159/000475773] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/10/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyze predictors of image quality for a handheld nonmydriatic fundus camera used for screening of vision-threatening diabetic retinopathy. METHODS An ophthalmic photographer at an Aravind Eye Hospital obtained nonmydriatic and mydriatic fundus images from 3 fields in 275 eyes of 155 participants over 13 months using a Smartscope camera (Optomed, Oulu, Finland) and a Topcon tabletop fundus camera (Topcon, Tokyo, Japan). Two fellowship-trained retina specialists graded the images. Repeated-measures logistic regression assessed predictors of the main outcome measure: gradability of the fundus images. RESULTS Of 2,475 images, 76.2% of the Smartscope nonmydriatic images, 90.1% of the Smartscope mydriatic images, and 92.0% of the Topcon mydriatic images were gradable. Eyes with vitreous hemorrhage (OR = 0.24, p < 0.0001) or advanced cataract (OR = 0.08, p < 0.0001) had decreased odds of image gradability. Excluding eyes with cataract or vitreous hemorrhage, nonmydriatic macular image gradability improved from 68.4% in the first set of 55 eyes to 94.6% in the final set of 55 eyes. CONCLUSION With sufficient training, paraprofessional health care staff can obtain high-quality images with a portable nonmydriatic fundus camera, particularly in patients with clear lenses and clear ocular media.
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Affiliation(s)
- Jose R Davila
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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Maa AY, Wojciechowski B, Hunt KJ, Dismuke C, Shyu J, Janjua R, Lu X, Medert CM, Lynch MG. Early Experience with Technology-Based Eye Care Services (TECS): A Novel Ophthalmologic Telemedicine Initiative. Ophthalmology 2017; 124:539-546. [PMID: 28081944 DOI: 10.1016/j.ophtha.2016.11.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The aging population is at risk of common eye diseases, and routine eye examinations are recommended to prevent visual impairment. Unfortunately, patients are less likely to seek care as they age, which may be the result of significant travel and time burdens associated with going to an eye clinic in person. A new method of eye-care delivery that mitigates distance barriers and improves access was developed to improve screening for potentially blinding conditions. We present the quality data from the early experience (first 13 months) of Technology-Based Eye Care Services (TECS), a novel ophthalmologic telemedicine program. DESIGN With TECS, a trained ophthalmology technician is stationed in a primary care clinic away from the main hospital. The ophthalmology technician follows a detailed protocol that collects information about the patient's eyes. The information then is interpreted remotely. Patients with possible abnormal findings are scheduled for a face-to-face examination in the eye clinic. PARTICIPANTS Any patient with no known ocular disease who desires a routine eye screening examination is eligible. METHODS Technology-Based Eye Care Services was established in 5 primary care clinics in Georgia surrounding the Atlanta Veterans Affairs hospital. MAIN OUTCOME MEASURES Four program operation metrics (patient satisfaction, eyeglass remakes, disease detection, and visit length) and 2 access-to-care metrics (appointment wait time and no-show rate) were tracked. RESULTS Care was rendered to 2690 patients over the first 13 months of TECS. The program has been met with high patient satisfaction (4.95 of 5). Eyeglass remake rate was 0.59%. Abnormal findings were noted in 36.8% of patients and there was >90% agreement between the TECS reading and the face-to-face findings of the physician. TECS saved both patient (25% less) and physician time (50% less), and access to care substantially improved with 99% of patients seen within 14 days of contacting the eye clinic, with a TECS no-show rate of 5.2%. CONCLUSIONS The early experience with TECS has been promising. Tele-ophthalmology has the potential to improve operational efficiency, reduce cost, and significantly improve access to care. Although further study is necessary, TECS shows potential to help prevent avoidable vision loss.
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Affiliation(s)
- April Y Maa
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
| | - Barbara Wojciechowski
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Kelly J Hunt
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Clara Dismuke
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Jason Shyu
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Rabeea Janjua
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Xiaoqin Lu
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | | | - Mary G Lynch
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
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Maa AY, Patel S, Chasan JE, Delaune W, Lynch MG. Retrospective Evaluation of a Teleretinal Screening Program in Detecting Multiple Nondiabetic Eye Diseases. Telemed J E Health 2017; 23:41-48. [DOI: 10.1089/tmj.2016.0039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- April Y. Maa
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Shivangi Patel
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
| | - Joel E. Chasan
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - William Delaune
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, Georgia
| | - Mary G. Lynch
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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Tan ACS, Fleckenstein M, Schmitz-Valckenberg S, Holz FG. Clinical Application of Multicolor Imaging Technology. Ophthalmologica 2016; 236:8-18. [PMID: 27404384 DOI: 10.1159/000446857] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/12/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the clinical application of multicolor imaging by confocal scanning laser ophthalmoscopy (cSLO). METHODS Retinal imaging was performed in 76 patients including cSLO multicolor imaging (SPECTRALIS SD-OCT, Heidelberg Engineering, Heidelberg, Germany) and color fundus photography (CFP). RESULTS The use of confocal optics, reduced light scatter and automated eye tracking enable high-resolution cSLO reflectance images. Compared to CFP, the appearance of pigment alterations and hemorrhages were some of the differences observed. Various artifacts including those derived from optical media alterations need to be considered when interpreting images. Specific pathological findings including epiretinal membranes, fibrovascular proliferations, and reticular pseudodrusen may be better visualized on multicolor images. CONCLUSIONS When using multicolor imaging, ophthalmologists need to be mindful about differences in the appearance of pathological changes and artifacts. Multicolor imaging may offer information over and above conventional CFP; it can be performed through undilated pupils and is less affected by media opacities.
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Affiliation(s)
- Anna C S Tan
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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Friedlander AH, Giaconi JA, Tsui I, Aghazadehsanai N, Chang TI, Garrett NR. Meaningful correlation between asymptomatic retinal arteriole emboli and calcified carotid plaque found on panoramic dental imaging of males with diabetes. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:434-40. [PMID: 26972542 DOI: 10.1016/j.oooo.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is ongoing controversy with regard to the stability of calcified carotid artery plaques (CCAPs) seen in the bifurcation area on panoramic images (PIs). Therefore, we sought to evaluate the possibility of these plaques shedding emboli by observing their relationship with ipsilateral retinal emboli. STUDY DESIGN The study group included 50 neurologically and visually asymptomatic males with diabetes, with PIs that incidentally demonstrated CCAPs (CCAP+) and contemporaneous digital retinal images that had been obtained for evaluation of diabetic retinopathy. The control group consisted of 50 males with diabetes who were matched for age and body mass index and had undergone both imaging studies and whose PIs were devoid of carotid plaques (CCAP-). The presence of retinal emboli was determined by two ophthalmologists blinded to the patients' medical histories, and the prevalence rates for the two groups were calculated. RESULTS The presence of asymptomatic retinal arteriolar emboli was found in the eye ipsilateral to the radiographically observed carotid atheroma in 10 of 50 (20%) of the patients in the CCAP+ group, compared with 2 of 50 (4%) in the CCAP- group, and this difference was statistically significant (Fisher's exact P < .03). CONCLUSIONS Some male patients with diabetes mellitus type II having calcified carotid artery atheromas in the bifurcation area, as visualized on PIs, may have significant sequelae as evidenced by retinal artery emboli.
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Affiliation(s)
- Arthur H Friedlander
- Associate Chief of Staff and Director of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director of Quality Assurance, Hospital Dental Service, Ronald Reagan UCLA Medical Center; Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA.
| | - JoAnn A Giaconi
- Chief of Ophthalmology, Veterans Affairs Greater Los Angeles Healthcare System; Associate Clinical Professor at the UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Irena Tsui
- Staff Ophthalmologist, Veterans Affairs Greater Los Angeles Healthcare System and Assistant Professor at the UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Nona Aghazadehsanai
- Oral and Maxillofacial Surgery Research Fellow, Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Tina I Chang
- Director of the Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Greater Los Angeles Healthcare System; Instructor of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Neal R Garrett
- Professor Emeritus, School of Dentistry, University of California, Los Angeles, CA, USA
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Knyazer B, Schachter O, Plakht Y, Serlin Y, Smolar J, Belfair N, Lifshitz T, Levy J. Epiretinal membrane in diabetes mellitus patients screened by nonmydriatic fundus camera. Can J Ophthalmol 2016; 51:41-6. [DOI: 10.1016/j.jcjo.2015.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/23/2015] [Accepted: 09/23/2015] [Indexed: 12/20/2022]
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A Novel Device to Exploit the Smartphone Camera for Fundus Photography. J Ophthalmol 2015; 2015:823139. [PMID: 26137320 PMCID: PMC4468345 DOI: 10.1155/2015/823139] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To construct an inexpensive, convenient, and portable attachment for smartphones for the acquisition of still and live retinal images. Methods. A small optical device based on the principle of direct ophthalmoscopy was designed to be magnetically attached to a smartphone. Representative images of normal and pathological fundi were taken with the device. Results. A field-of-view up to ~20° was captured at a clinical resolution for each fundus image. The cross-polarization technique adopted in the optical design dramatically diminished corneal Purkinje reflections, making it possible to screen patients even through undilated pupils. Light emission proved to be well within safety limits. Conclusions. This optical attachment is a promising, inexpensive, and valuable alternative to the direct ophthalmoscope, potentially eliminating problems of poor exam skills and inexperienced observer bias. Its portability, together with the wireless connectivity of smartphones, presents a promising platform for screening and telemedicine in nonhospital settings. Translational Relevance. Smartphones have the potential to acquire retinal imaging for a portable ophthalmoscopy.
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Lengyel I, Csutak A, Florea D, Leung I, Bird AC, Jonasson F, Peto T. A Population-Based Ultra-Widefield Digital Image Grading Study for Age-Related Macular Degeneration-Like Lesions at the Peripheral Retina. Ophthalmology 2015; 122:1340-7. [PMID: 25870081 DOI: 10.1016/j.ophtha.2015.03.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Our understanding of the relevance of peripheral retinal abnormalities to disease in general and in age-related macular degeneration (AMD) in particular is limited by the lack of detailed peripheral imaging studies. The purpose of this study was to develop image grading protocols suited to ultra-widefield imaging (UWFI) in an aged population. DESIGN A cross-sectional study of a random population sample in which UWFI was introduced at the 12-year review of the Reykjavik Eye Study in Iceland. PARTICIPANTS Five hundred seventy-six subjects 62 years of age or older. METHODS Ultra-widefield (up to 200°) color and autofluorescence images were obtained using the Optos P200CAF laser scanning ophthalmoscope (Optos plc, Dunfermline, Scotland). The images were graded at Moorfields Eye Hospital Reading Centre primarily based on the International Classification for AMD. Macular and peripheral changes were graded using a standardized grid developed for this imaging method. MAIN OUTCOME MEASURES Presence or absence of hard, crystalline, and soft drusen; retinal pigment epithelial changes; choroidal neovascularization (CNV); atrophy; and hypoautofluorescence and hyperautofluorescence were graded in the peripheral retina. RESULTS Of the eyes examined, 81.1% had AMD-like changes in the macula alone (13.6%), periphery alone (10.1%), and both periphery and macula (57.4%). There was no AMD-like CNV or pigment epithelial detachment in the periphery except in those cases in which these clearly originated from the macula. Seven patients had AMD-like atrophy in the periphery without end-stage disease in the macula. One patient with end-stage disease in the macula had normal periphery results on the color images. While analyzing the eyes, we detected pathologic appearances that were very reliably identified by graders. CONCLUSIONS Phenotyping the retinal periphery using the categories defined by the International Classification confirmed the presence of wide-ranging AMD-like pathologic changes even in those without central sight-threatening macular disease. Based on our observations, we propose here new, reliably identifiable grading categories that may be more suited for population-based UWFI.
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Affiliation(s)
- Imre Lengyel
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Adrienne Csutak
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniela Florea
- UCL Institute of Ophthalmology, University College London, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Irene Leung
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alan C Bird
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | | | - Tunde Peto
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
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Comparison of smartphone ophthalmoscopy with slit-lamp biomicroscopy for grading diabetic retinopathy. Am J Ophthalmol 2015; 159:360-4.e1. [PMID: 25447109 DOI: 10.1016/j.ajo.2014.11.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/30/2014] [Accepted: 11/02/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the accuracy and reliability of smartphone ophthalmoscopy, we compared the ability of a smartphone ophthalmoscope with that of a slit-lamp biomicroscope to grade diabetic retinopathy (DR) in patients with diabetes mellitus (DM). DESIGN Clinical-based, prospective, comparative instrument study. METHODS This comparative clinical study was performed in 120 outpatients (240 eyes) with type 1 or type 2 DM. After pupil dilation, the patients underwent smartphone ophthalmoscopy with the D-Eye device, followed by dilated retinal slit-lamp examination, to grade DR according to a 5-step scale. RESULTS Overall exact agreement between the 2 methods was observed in 204 of 240 eyes (85%) (simple κ = 0.78; CI 0.71-0.84) and agreement within 1 step was observed in 232 eyes (96.7%). Compared to biomicroscopy, the sensitivity and specificity of smartphone ophthalmoscopy for the detection of clinically significant macular edema were 81% and 98%, respectively. Smartphone ophthalmoscopy and biomicroscopy could not be used to examine the fundus and grade DR in 9 eyes (3.75%) and 4 eyes (1.7%), respectively, because of cataract and/or small pupil diameter. CONCLUSION Smartphone ophthalmoscopy showed considerable agreement with dilated retinal biomicroscopy for the grading of DR. The portability, affordability, and connectivity of a smartphone ophthalmoscope make smartphone ophthalmoscopy a promising technique for community screening programs.
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Creuzot-Garcher C, Martin-Phipps T, Beynat J, Astruc K, Brassac K, Bron AM. Effectiveness of a mobile diabetic retinopathy screening campaign to encourage diabetics to undergo regular ophthalmic follow-up. Ophthalmic Res 2014; 52:206-11. [PMID: 25402747 DOI: 10.1159/000363326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/26/2014] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the effectiveness of a mobile diabetic retinopathy (DR) screening campaign with a non-mydriatic camera to encourage diabetics to undergo a subsequent ophthalmic follow-up. METHODS Diabetic patients who underwent free DR screening with a non-mydriatic fundus camera were given the recommendation to have an ophthalmic visit, in a time frame suited to the DR stage or in case abnormalities in the macula, the optic nerve or intra-ocular pressure were detected. The photographs were performed by a trained orthoptist. The date of the visit to their ophthalmologist and the report of this consultation were recorded. RESULTS During 5 annual campaigns, 4,699 diabetics were screened. Of the 1,573 ophthalmic examinations recommended at the screening, 1,241 (79%) were actually conducted. A total of 623 new cases of DR were found in the course of this screening campaign, with a fair concordance between the diagnosis suggested at screening and the examination by the ophthalmologist (κ = 0.48). CONCLUSION Information and recommendations given during DR screening helped to reintroduce patients to a regular ophthalmic follow-up, at least in the short term.
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22
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Read O, Cook C. Retinopathy in diabetic patients evaluated at a primary care clinic in Cape Town. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2007.10872158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Silva PS, Cavallerano JD, Tolls D, Omar A, Thakore K, Patel B, Sehizadeh M, Tolson AM, Sun JK, Aiello LM, Aiello LP. Potential efficiency benefits of nonmydriatic ultrawide field retinal imaging in an ocular telehealth diabetic retinopathy program. Diabetes Care 2014; 37:50-5. [PMID: 23939541 DOI: 10.2337/dc13-1292] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare efficiency of nonmydriatic ultrawide field retinal imaging (UWFI) and nonmydriatic fundus photography (NMFP) in a diabetic retinopathy (DR) ocular telehealth program. RESEARCH DESIGN AND METHODS Patients in this retrospective, comparative cohort study underwent NMFP and UWFI between 1 November 2011 and 1 November 2012. Images were evaluated for DR and diabetic macular edema (DME) by certified graders using a standard protocol at a centralized reading center. Identification of DR, image evaluation time, and rate of ungradable eyes were compared. RESULTS NMFP and UWFI were performed in 1,633 and 2,170 consecutive patients, respectively. No statistically significant differences were found between groups regarding age, diabetes duration, sex, ethnicity, or insulin use. The ungradable rate per patient for DR (2.9 vs. 9.9%, P < 0.0001) and DME (3.8 vs. 8.8%, P < 0.0001) was lower with UWFI than with NMFP. With UWFI, the median image evaluation time per patient was reduced from 12.8 to 9.2 min (P < 0.0001). The identification of patients with DR (38.4 vs. 33.8%) and vision-threatening DR (14.5 vs. 11.9%) was increased with UWFI versus NMFP. In a consecutive subgroup of 502 eyes of 301 patients with DR, the distribution of peripheral retinal lesions outside Early Treatment Diabetic Retinopathy Study fields suggested a more severe DR level in 9.0% (45 eyes). CONCLUSIONS In a standardized DR ocular telehealth program, nonmydriatic UWFI reduced the ungradable rate by 71% (to <3%) and reduced image evaluation time by 28%. DR was identified 17% more frequently after UWFI, and DR peripheral lesions suggested a more severe DR level in 9%. These data suggest that UWFI may improve efficiency of ocular telehealth programs evaluating DR and DME.
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Mizrachi Y, Knyazer B, Guigui S, Rosen S, Lifshitz T, Belfair N, Klemperer I, Schneck M, Levy J. Evaluation of diabetic retinopathy screening using a non-mydriatic retinal digital camera in primary care settings in south Israel. Int Ophthalmol 2013; 34:831-7. [PMID: 24292883 DOI: 10.1007/s10792-013-9887-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/17/2013] [Indexed: 11/26/2022]
Abstract
To evaluate the effectiveness of the non-mydriatic digital camera for diabetic retinopathy (DR) screening. Secondary purposes of the study were to characterize diabetic patients being screened for the presence of DR and to calculate the sensitivity, specificity, and positive predictive value of the test. All 6,962 consecutive patients with type 2 diabetes undergoing non-mydriatic digital retinal photography between January 1, 2009 and June 30, 2010 in eight community health clinics in the south of the country were included. Comparison of a random sample of patients who underwent non-mydriatic retinal photography, and who were also examined by an ophthalmologist with pupil dilation was also performed. The average age of all patients was 64.2 years. A total of 5,960 cases (85.6 % of all photographs) were of adequate quality for the diagnosis. DR of any degree was found in 1,092 (18.3 %) patients. Normal fundus pictures were found in 49.4 % of patients. In 32.2 % of cases, non-DR pathologies were found. Among cases in which DR was found, 73.3 % (801 cases) had mild non-proliferative retinopathy (NPDR), 7.1 % (77 cases) had moderate NPDR, 6.8 % (74 cases) had proliferative retinopathy, and 12.8 % (140 cases) had diabetic macular edema. Older patients had more chance of having poor quality pictures (p < 0.001 between patients older and younger than 70 years). When non-mydriatic fundus photography was compared with dilated fundus examination by an ophthalmologist, sensitivity of 99.3 %, specificity of 88.3 %, and positive predictive value of 85.3 % were found. Non-mydriatic digital retinal photography is an efficient method for DR screening. The test has high sensitivity and specificity. The test, as performed in community health centers in the south of the country, contributed to the early diagnosis of >1,000 cases of DR. Many patients can be followed up in a fast and efficient way, although the test cannot replace a complete eye examination after pupil dilation mainly in older people. Other non-DR sight-threatening ocular pathologies can be also detected.
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Affiliation(s)
- Yossi Mizrachi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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Brown K, Sewell JM, Trempe C, Peto T, Travison TG. Comparison of image-assisted versus traditional fundus examination. Eye Brain 2013; 5:1-8. [PMID: 28539783 DOI: 10.2147/eb.s37646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the ability of image-assisted fundus examination to detect retinal lesions compared with traditional fundus examination. METHODS Subjects were imaged using a nonmydriatic ultrawide field scanning laser ophthalmoscope. After imaging, subjects underwent both a traditional and an image-assisted fundus examination, in random order. During the image-assisted method, ultrawide field scanning laser ophthalmoscopic images were reviewed in conjunction with a dilated fundus examination. Lesions detected by each method were assigned to one of three regions, ie, optic disc, posterior pole/macula, or mid-to-peripheral retina. Discrepancies between the image-assisted and the traditional examination methods were adjudicated by a retinal ophthalmologist. RESULTS In total, 170 subjects (339 eyes) were recruited. Agreement between image-assisted and traditional fundus examination varied by lesion type and was excellent for staphyloma (kappa 0.76), fair for suspicious cupping (kappa 0.66), drusen in the posterior pole/macula and mid-to-peripheral retina (0.45, 0.41), retinal pigment epithelial changes in the posterior pole/macula (0.54), peripheral retinal degeneration (0.50), cobblestone (0.69), vitreoretinal interface abnormalities (0.40), and vitreous lesions (0.53). Agreement was poor for hemorrhage in the mid-to-peripheral retina (kappa 0.33), and nevi in the mid-to-peripheral retina (0.34). When the methods disagreed, the results indicated a statistically significant advantage for the image-assisted examination in detecting suspicious cupping (P = 0.04), drusen in the posterior pole/macula and mid-to-peripheral retina (P = 0.004, P < 0.001), retinal pigment epithelial changes in the posterior pole/macula (P = 0.04), nevi in the posterior pole/macula and mid-to-peripheral retina (P = 0.01, P = 0.007), peripheral retinal degeneration (P < 0.001), hemorrhage in the mid-to-peripheral retina (P = 0.01), and vitreous lesions (P < 0.001). CONCLUSION Image-assisted fundus examination may enhance detection of retinal lesions compared with traditional fundus examination alone.
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Affiliation(s)
- Kristen Brown
- New England College of Optometry.,New England Eye Institute, Boston, MA, USA
| | - Jeanette M Sewell
- New England College of Optometry.,New England Eye Institute, Boston, MA, USA
| | | | - Tunde Peto
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Thomas G Travison
- Department of Medicine.,Department of Biostatistics, Boston University School of Medicine, Boston, MA, USA
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Bursell SE, Brazionis L, Jenkins A. Telemedicine and ocular health in diabetes mellitus. Clin Exp Optom 2012; 95:311-27. [PMID: 22594547 DOI: 10.1111/j.1444-0938.2012.00746.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Teleretinal/teleophthalmological programs that use existing health information technology infrastructure solutions for people with diabetes increase access to and adherence to appropriate eye care. Teleophthalmological studies indicate that the single act of patients viewing their own retinal images improves self-management behaviour and clinical outcomes. In some settings this can be done at lower cost and with improved visual outcomes compared with standard eye care. Cost-effective and sustainable teleretinal surveillance for detection of diabetic retinopathy requires a combination of an inexpensive portable device for taking low light-level retinal images without the use of pharmacological dilation of the pupil and a computer-assisted methodology for rapidly detecting and diagnosing diabetic retinopathy. A more holistic telehealth-care paradigm augmented with the use of health information technology, medical devices, mobile phone and mobile health applications and software applications to improve health-care co-ordination, self-care management and education can significantly impact a broad range of health outcomes, including prevention of diabetes-associated visual loss. This approach will require a collaborative, transformational, patient-centred health-care program that integrates data from medical record systems with remote monitoring of data and a longitudinal health record. This includes data associated with social media applications and personal mobile health technology and should support continuous interactions between the patient, health-care team and the patient's social environment. Taken together, this system will deliver contextually and temporally relevant decision support to patients to facilitate their well-being and to reduce the risk of diabetic complications.
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Affiliation(s)
- Sven-Erik Bursell
- The University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
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Silva PS, Walia S, Cavallerano JD, Sun JK, Dunn C, Bursell SE, Aiello LM, Aiello LP. Comparison of low-light nonmydriatic digital imaging with 35-mm ETDRS seven-standard field stereo color fundus photographs and clinical examination. Telemed J E Health 2012; 18:492-9. [PMID: 22827402 DOI: 10.1089/tmj.2011.0232] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare agreement between diagnosis of clinical level of diabetic retinopathy (DR) and diabetic macular edema (DME) derived from nonmydriatic fundus images using a digital camera back optimized for low-flash image capture (MegaVision) compared with standard seven-field Early Treatment Diabetic Retinopathy Study (ETDRS) photographs and dilated clinical examination. Subject comfort and image acquisition time were also evaluated. SUBJECTS AND METHODS In total, 126 eyes from 67 subjects with diabetes underwent Joslin Vision Network nonmydriatic retinal imaging. ETDRS photographs were obtained after pupillary dilation, and fundus examination was performed by a retina specialist. RESULTS There was near-perfect agreement between MegaVision and ETDRS photographs (κ=0.81, 95% confidence interval [CI] 0.73-0.89) for clinical DR severity levels. Substantial agreement was observed with clinical examination (κ=0.71, 95% CI 0.62-0.80). For DME severity level there was near-perfect agreement with ETDRS photographs (κ=0.92, 95% CI 0.87-0.98) and moderate agreement with clinical examination (κ=0.58, 95% CI 0.46-0.71). The wider MegaVision 45° field led to identification of nonproliferative changes in areas not imaged by the 30° field of ETDRS photos. Field area unique to ETDRS photographs identified proliferative changes not visualized with MegaVision. Mean MegaVision acquisition time was 9:52 min. After imaging, 60% of subjects preferred the MegaVision lower flash settings. CONCLUSIONS When evaluated using a rigorous protocol, images captured using a low-light digital camera compared favorably with ETDRS photography and clinical examination for grading level of DR and DME. Furthermore, these data suggest the importance of more extensive peripheral images and suggest that utilization of wide-field retinal imaging may further improve accuracy of DR assessment.
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Affiliation(s)
- Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts 02215, USA
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Maker MP, Noble J, Silva PS, Cavallerano JD, Murtha TJ, Sun JK, Aiello LM, Bursell SE, Aiello LP. Automated Retinal Imaging System (ARIS) compared with ETDRS protocol color stereoscopic retinal photography to assess level of diabetic retinopathy. Diabetes Technol Ther 2012; 14:515-22. [PMID: 22385213 DOI: 10.1089/dia.2011.0270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Early Treatment Diabetic Retinopathy Study (ETDRS) seven-standard-field color stereoscopic retinal photography (ETDRS photos) has been a gold standard for determining diabetic retinopathy (DR) severity. The Automated Retinal Imaging System (ARIS™, model 110, Visual Pathways, Inc., Prescott, AZ) acquires seven-sequential color stereoscopic digital images (ARIS images) by a semiautomated technician-run process generally corresponding to ETDRS photos. We assessed the correlation between a single semiautomated ARIS imaging session without any re-imaging and ETDRS photos performed by a certified photographer for the determination of DR severity. METHODS Two independent masked readers graded mydriatic ARIS images and ETDRS photos. A third masked retinal specialist adjudicated discrepancies. Correlation between the two modalities was compared using weighted-κ statistics. RESULTS We evaluated 211 eyes of 106 patients with varying levels of DR. Partially ungradable images were present in 3.4% of ETDRS photos versus 31.8% of ARIS images. Exact agreement and agreement within one level between ETDRS photos and ARIS images using only completely gradable image sets occurred in 69% (κ=0.81) and 90% of cases, respectively. Exact agreement for clinically significant macular edema was 92.1% (κ=0.59). There was 100% agreement for eyes with high-risk proliferative DR. Within one level of DR severity, 100% agreement occurred for the following: questionable nonproliferative DR (NPDR), moderate NPDR, and severe NPDR. CONCLUSIONS Results suggest that semiautomated ARIS images compare favorably with ETDRS photos when full image sets can be obtained; however, partially ungradable image sets occurred almost 10 times more frequently with ARIS images than with ETDRS photos. In the two-thirds of cases where ARIS images can be utilized, ARIS can obtain retinal images comparable to ETDRS photos while requiring less highly trained personnel than generally needed for standard ETDRS photos.
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Affiliation(s)
- Manvi P Maker
- Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02215, USA
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Guigui S, Lifshitz T, Levy J. Screening for diabetic retinopathy: review of current methods. Hosp Pract (1995) 2012; 40:64-72. [PMID: 22615080 DOI: 10.3810/hp.2012.04.971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To review the current screening methods for diabetic retinopathy, with a focus on nonmydriatic digital fundus photography. METHODS Articles from Medline were reviewed from 1976 to November 2011 for different combinations of the words "diabetic retinopathy," "screening," "fundus photography," and "nonmydriasis." RESULTS Because of its ease of use and cost-effectiveness, digital fundus photography is becoming the preferred method for diagnosing diabetic retinopathy. Current research has proven that pupillary dilation is not a necessary step in the fundus examination, although it reduces the number of unnecessary referrals to ophthalmologists. Automated grading systems, while saving time and reducing human error, still need refinement before they can replace manual grading by trained ophthalmologists. CONCLUSION Nonmydriatic digital fundus photography with manual grading by a trained technician is an acceptable method of screening for diabetic retinopathy.
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Affiliation(s)
- Sarah Guigui
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Cavallerano JD, Silva PS, Tolson AM, Francis T, Tolls D, Patel B, Eagan S, Aiello LM, Aiello LP. Imager evaluation of diabetic retinopathy at the time of imaging in a telemedicine program. Diabetes Care 2012; 35:482-4. [PMID: 22238278 PMCID: PMC3322720 DOI: 10.2337/dc11-1317] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the ability of certified retinal imagers to identify presence versus absence of sight-threatening diabetic retinopathy (stDR) (moderate nonproliferative diabetic retinopathy or worse or diabetic macular edema) at the time of retinal imaging in a telemedicine program. RESEARCH DESIGN AND METHODS Diabetic patients in a primary care setting or specialty diabetes clinic received Joslin Vision Network protocol retinal imaging as part of their care. Trained nonphysician imagers graded the presence versus absence of stDR at the time of imaging. These gradings were compared with masked gradings of certified readers. RESULTS Of 158 patients (316 eyes) imaged, all cases of stDR (42 eyes [13%]) were identified by the imagers at the time of imaging. Six eyes with mild nonproliferative diabetic retinopathy were graded by the imagers to have stDR (sensitivity 1.00, 95% CI 0.90-1.00; specificity 0.97, 0.94-0.99). CONCLUSIONS Appropriately trained imagers can accurately identify stDR at the time of imaging.
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Rein DB, Wittenborn JS, Zhang X, Allaire BA, Song MS, Klein R, Saaddine JB. The cost-effectiveness of three screening alternatives for people with diabetes with no or early diabetic retinopathy. Health Serv Res 2011; 46:1534-61. [PMID: 21492158 PMCID: PMC3166398 DOI: 10.1111/j.1475-6773.2011.01263.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine whether biennial eye evaluation or telemedicine screening are cost-effective alternatives to current recommendations for the estimated 10 million people aged 30-84 with diabetes but no or minimal diabetic retinopathy. DATA SOURCES United Kingdom Prospective Diabetes Study, National Health and Nutrition Examination Survey, American Academy of Ophthalmology Preferred Practice Patterns, Medicare Payment Schedule. STUDY DESIGN Cost-effectiveness Monte Carlo simulation. DATA COLLECTION/EXTRACTION METHODS Literature review, analysis of existing surveys. PRINCIPAL FINDINGS Biennial eye evaluation was the most cost-effective treatment option when the ability to detect other eye conditions was included in the model. Telemedicine was most cost-effective when other eye conditions were not considered or when telemedicine was assumed to detect refractive error. The current annual eye evaluation recommendation was costly compared with either treatment alternative. Self-referral was most cost-effective up to a willingness to pay (WTP) of U.S.$37,600, with either biennial or annual evaluation most cost-effective at higher WTP levels. CONCLUSIONS Annual eye evaluations are costly and add little benefit compared with either plausible alternative. More research on the ability of telemedicine to detect other eye conditions is needed to determine whether it is more cost-effective than biennial eye evaluation.
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Affiliation(s)
- David B Rein
- RTI International, 2951 Flowers Road, Atlanta, GA 30341, USA.
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Sanchez CR, Silva PS, Cavallerano JD, Aiello LP, Aiello LM. Ocular telemedicine for diabetic retinopathy and the Joslin Vision Network. Semin Ophthalmol 2011; 25:218-24. [PMID: 21091003 DOI: 10.3109/08820538.2010.518893] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. The Joslin Vision Network Diabetes Eye Care Program (JVN) is a validated ocular telemedicine program developed at the Joslin Diabetes Center that has provided diabetes eye care to over 70,000 persons. The JVN allows accurate assessment of level of DR severity, detects the presence of nondiabetic eye disease, and allows determination of appropriate treatment recommendations. The JVN integrates eye care in a comprehensive diabetes program, extends access to evidence-based diabetes eye care, and offers alternative means of diabetes eye care in appropriate settings, ultimately preserving vision and preventing visual loss.
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Friedman DS, Ali F, Kourgialis N. Diabetic retinopathy in the developing world: how to approach identifying and treating underserved populations. Am J Ophthalmol 2011; 151:192-4.e1. [PMID: 21251492 DOI: 10.1016/j.ajo.2010.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/07/2010] [Accepted: 10/11/2010] [Indexed: 11/28/2022]
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Abstract
Diabetic retinopathy (DR) is a common complication of diabetes mellitus and a leading cause of new-onset vision loss in adults worldwide. Current medical and surgical evidence-based care, including laser photocoagulation, is effective in preserving vision. This care is most effective prior to the onset of ocular or visual symptoms, but many diabetic persons do not receive the recommended annual eye examination for the evaluation of the retina for level of DR. With diabetes incidence and prevalence increasing at epidemic rates and the prediction that 370 million people worldwide will have diabetes by the year 2030, human and fiscal resources will be unable to meet the visual needs with current acute care methods. Appropriate and validated telemedicine programs for DR hold the promise of both enrolling patients into appropriate eye care programs and, more importantly, providing more effective, high-quality diabetes eye care based on current and developing technology.
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Affiliation(s)
- Ingrid E Zimmer-Galler
- Ophthalmic Physics Laboratory, Wilmer Eye Institute/Woods 355, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Interobserver and intraobserver reliability of detecting age-related macular degeneration using a nonmydriatic digital camera. Am J Ophthalmol 2008; 146:520-526. [PMID: 18619569 DOI: 10.1016/j.ajo.2008.05.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Revised: 05/20/2008] [Accepted: 05/21/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the interobserver and intraobserver reliability of detecting early and late age-related macular degeneration (AMD) using a nonmydriatic digital camera in two distinct groups of older people. DESIGN Prospective study. METHODS The two groups consisted of a series of patients older than 70 years hospitalized in a geriatric unit and a younger series of people older than 55 years. In both groups, nonmydriatic color fundus photographs were obtained and graded independently by two ophthalmologists (V.L. and M.S.). No ophthalmic examination was performed. Main outcome measures were frequencies of early and late AMD and interobserver and intraobserver agreement. RESULTS Among 233 patients in group 1 (mean age, 84.6 years), only 119 patients (51%) could undergo photography because of associated multiple morbidities. Mean age of group 2 was 63.8 years. In group 1, 35 (14.5%) of 238 pictures were ungradable. In series 2, 65 (9.1%) of 716 pictures were ungradable. Frequencies of early and late AMD were 30.3% and 5.9% vs 12.6% and 2.6% in series 1 and 2, respectively. Interobserver and intraobserver agreement was good or excellent (kappa > 0.6) in both groups. CONCLUSIONS In the entire geriatric cohort, 43% of the patients had gradable pictures allowing a diagnosis. These patients would otherwise have had no access to any form of funduscopy. In the younger population, nonmydriatic pictures permitted a diagnosis in 90% of the individuals. Detection of AMD with a nonmydriatic digital camera may lead to large-scale screening and specific management.
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Fonda SJ, Paulsen CA, Perkins J, Kedziora RJ, Rodbard D, Bursell SE. Usability test of an internet-based informatics tool for diabetes care providers: the comprehensive diabetes management program. Diabetes Technol Ther 2008; 10:16-24. [PMID: 18275359 DOI: 10.1089/dia.2007.0252] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Research suggests Internet-based care management tools are associated with improvements in care and patient outcomes. However, although such tools change workflow, rarely is their usability addressed and reported. This article presents a usability study of an Internet-based informatics application called the Comprehensive Diabetes Management Program (CDMP), developed by content experts and technologists. Our aim is to demonstrate a process for conducting a usability study of such a tool and to report results. METHODS We conducted the usability test with six diabetes care providers under controlled conditions. Each provider worked with the CDMP in a single session using a "think aloud" process. Providers performed standardized tasks with fictitious patient data, and we observed how they approached these tasks, documenting verbalizations and subjective ratings. The providers then completed a usability questionnaire and interviews. RESULTS Overall, the scores on the usability questionnaire were neutral to favorable. For specific subdomains of the questionnaire, the providers' reported problems with the application's ease of use, performance, and support features, but were satisfied with its visual appeal and content. The results from the observational and interview data indicated areas for improvement, particularly in navigation and terminology. CONCLUSIONS The usability study identified several issues for improvement, confirming the need for usability testing of Internet-based informatics applications, even those developed by experts. To our knowledge, there have been no other usability studies of an Internet-based informatics application with the functionality of the CDMP. Such studies can form the foundation for translation of Internet-based medical informatics tools into clinical practice.
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Fonda SJ, Bursell SE, Lewis DG, Garren J, Hock K, Cavallerano J. The Relationship of a Diabetes Telehealth Eye Care Program to Standard Eye Care and Change in Diabetes Health Outcomes. Telemed J E Health 2007; 13:635-44. [DOI: 10.1089/tmj.2007.0025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Stephanie J. Fonda
- Joslin Diabetes Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sven-Erik Bursell
- Joslin Diabetes Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Khouri AS, Szirth BC, Bhagat N, Fechtner RD. Screening and diabetes mellitus. Ophthalmology 2007; 114:398-9; author reply 399-400. [PMID: 17270698 DOI: 10.1016/j.ophtha.2006.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 10/10/2006] [Indexed: 11/17/2022] Open
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Aiello LM, Bursell SE, Cavallerano J, Aiello LP. Author reply. Ophthalmology 2007. [DOI: 10.1016/j.ophtha.2006.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bibliography. Current world literature. Neuro-ophthalmology. Curr Opin Ophthalmol 2006; 17:574-5. [PMID: 17065928 DOI: 10.1097/icu.0b013e32801121a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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