TELEMEDICINE DIAGNOSIS OF EYE DISORDERS BY DIRECT OPHTHALMOSCOPY - A PILOT-STUDY

Objective: To report a pilot study of telemedical direct ophthalmoscop y in the diagnosis of acquired immune deficiency syndrome (AIDS)-relat ed retinopathy in a human immunodeficiency virus (HIV)-positive popula tion and in the diagnosis of glaucoma, cataract, and retinopathy in a diabetic population. Design: Prospective comparative case series. Part icipants: Seventeen HIV-positive and 20 diabetic patients. Methods: A direct ophthalmoscope custom-fitted with a digital microcamera capable of transmitting images from any of 61 sites within the Georgia Statew ide Telemedicine Program was used by a nonophthalmologist to examine 3 4 eyes of 17 HIV-positive patients and 39 eyes of 20 patients with dia betes. Fundus images were transmitted in real-time to a reviewing opht halmologist. An in-person, comprehensive examination including indirec t ophthalmoscopy, was performed by a second ophthalmologist, Telemedic al examination was compared to the in-person comprehensive examination . Results: For the HIV study, 21 eyes did not show HIV retinopathy (no ninfectious retinopathy with cotton-wool spots) by in-person examinati on. Telemedical examination correctly identified 20 of these eves as d isease-free (specificity = 95%), HIV retinopathy was present ir 12 of the 34 eyes by in-person evaluation with telemedical examination corre ctly diagnosing 10 of these eyes (sensitivity = 83%). One eye with den se cataract and retinal detachment was unable to be evaluated ophthalm oscopically by either in-person or telemedical examination. Telemedica l and in-person assessments for HIV retinopathy were identical in 100% of eyes without cataract. Disagreement in diagnosis between telemedic al and in-person examination was associated with cataract (P < 0.0007) . For the diabetes study, because of an inadequate image, telemedical examination was unable to classify 46% and 36% of eyes for glaucoma an d diabetic retinopathy, respectively. Inability to make a telemedical determination for glaucoma (P < 0.011), nonproliferative (P < 0.064) a nd proliferative (P < 0.064) diabetic retinopathy was associated with cataract. Of the eyes that were able to be assessed by telemedical exa mination for diabetic retinopathy (n = 25), glaucoma (n = 21), and cat aract (n = 39), the accuracy was poor (sensitivity = 29%, 50%, and 41% , respectively), Telemedical examination for diabetic retinopathy and glaucoma was more likely to agree with in-person examination in eyes w ithout cataract as compared to eyes with cataract (not statistically s ignificant).Conclusion: Telemedical direct ophthalmoscopic, real-time fundus imaging may provide a valuable means for providing ophthalmic c onsultation to the primary care physician in younger patients without lens or media opacity, but is inadequate for eyes with any degree of l ens or media opacity.