[eOphthalmology: current state and future tendencies]

A systematic review of teleophthalmological studies in Europe

A systematic review of the recent literature regarding a series of ocular diseases involved in European telemedicine projects was performed based on the PubMed, Google Scholar and Springer databases in June 2017. Literature review returned 44 eligible studies; among them, emergency ophthalmology, diabetic retinopathy, glaucoma, age-related macular disease, cataract and retinopathy of prematurity. The majority of studies indicate teleophthalmology as a valid, reliable and cost-efficient method for care-provision in ophthalmology patients which delivers comparable outcomes to the traditional examination methods.

[Assessment of the use of retinography as a screening method for the early diagnosis of chronic glaucoma in Primary Care: Validation for screening in populations with open-angle glaucoma risk factors]

OBJECTIVE

The aim of this study is to determine usefulness, validity of retinographies performed in Primary Care as a tool for early diagnosis of open-angle chronic glaucoma (OAG).

DESIGN

An observational, descriptive and cross-sectional study with two blinded parallel observers: 2 general practitioners and 1 ophthalmologist.

LOCATION

Urban Primary Care Health Centre, and the Ophthalmology Department outpatient clinic.

PARTICIPANTS

A total of 196 patients of both genders, between 40-70years, with diabetes and hypertension, and undiagnosed with glaucoma, were recruited by phone call after checking patient lists. Two patients that did not arrive for their appointments for the ophthalmology tests were considered as losses.

MEASUREMENTS

For the quantitative diagnostic variable of glaucoma: Accuracy calculated from the sensitivity and specificity, safety from the positive and negative predictive values and the positive and negative probability ratio; interobserver concordance by Kappa index ratio and the intraclass correlation (IC).

RESULTS

The retinography for OAG screening has a sensitivity of 21% (95%CI: 0-43%), a specificity of 93% (95%CI: 89-97%), a negative predictive value of 94% (95%CI: 90-97%), and positive of 20% (95%CI: 0-40%); positive probability ratio of 3.07 (95%CI: 0.98-9.62) and negative 0.84 (95%CI: 0.64-1.11). The IC was 0.653 (95%CI: 0.495-0.769) and kappa index of 0.140 (0.106ET).

CONCLUSIONS

According to this proposed model, retinography is not a useful tool for the early diagnosis of OAG in Primary Care, as it is not safe enough. Before it can be used, it would need adjustments for its low sensitivity, and the use other combined tests. The training of general practitioners would also need to be improved.