Prospective Comparative Study Investigating Agreement between Tele-Ophthalmology and Face-to-face Consultations in Patients Presenting with Chronic Visual Loss

Jasper Ka-Wai Wong, Ming Ming Zhu, Jason Chi-Hang Lam, Keith Man-Kei Leung, Jin Xiao Lian, Cindy Lo-Kuen Lam, Kendrick Co Shih (Corresponding Author), Jimmy Shiu-Ming Lai (Corresponding Author)

Research output: Journal article publicationJournal articleAcademic researchpeer-review

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 κ values of > 0.8, while diagnosis and grading of glaucoma reached 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.
Original languageEnglish
Pages (from-to)1199-1213
Number of pages15
JournalOphthalmology and Therapy
Volume11
Issue number3
DOIs
Publication statusPublished - 13 Apr 2022

Keywords

  • Tele-ophthalmology
  • rospective comparative trial
  • Cataracts
  • Glaucoma
  • Age-related macular degeneration
  • Chronic visual loss

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