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Accuracy of a technology-assisted eye exam in evaluation of referable diabetic retinopathy and concomitant ocular diseases
  1. Paul R Conlin1,2,
  2. Baharak Asefzadeh1,3,
  3. Louis R Pasquale2,4,5,
  4. Gerald Selvin1,3,
  5. Rebecca Lamkin1,
  6. Anthony A Cavallerano1,3
  1. 1Department of Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3New England College of Optometry, Boston, Massachusetts, USA
  4. 4Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  5. 5Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Baharak Asefzadeh, Department of Optometry, VA Boston Healthcare System (112), 150 S. Huntington Avenue, Boston, MA 02130, USA; Baharak.Asefzadeh{at}va.gov

Abstract

Background/aims Digital retinal imaging using store-and-forward technology is used to screen for diabetic retinopathy (DR). Its usefulness in detecting non-diabetic eye diseases is uncertain. We determined the level of agreement between teleretinal imaging supplemented with visual acuity and intraocular pressure (IOP) measurements (ie, technology-assisted eye (TAE) exam) and a comprehensive eye exam in evaluation for DR and non-diabetic ocular conditions.

Methods We conducted a prospective, observational study with two parallel evaluations. Patients with diabetes (n=317) had a TAE exam and a comprehensive eye exam on the same day. A subset of participants with normal baseline exams (n=72) had follow-up exams 1 year later. We measured the level of agreement for referable ocular findings.

Results Agreement for referable ocular findings was moderate (n=389, agreement: 77%; κ: 0.55), due in part to ungradable exams (22%). However, about half of the ungradable exams had findings that warranted referral. There was substantial agreement for follow-up exams (n=72, agreement: 93%; κ: 0.63). Among all gradable exams (n=303), the TAE exam had 86% sensitivity and 84% specificity for referable ocular findings, with high agreement (≥94%) for DR and other major ocular diagnoses.

Conclusions There was moderate-to-substantial agreement between a TAE exam and a comprehensive eye exam for referable ocular findings in patients with diabetes. Ungradable exams were a frequent marker of ocular pathology. Teleretinal imaging may be a useful evaluation for both diabetic and non-diabetic ocular conditions.

  • Telemedicine
  • Imaging

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