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  • Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses

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Clinical science
Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses
  1. Lisa A Hark1,2,
  2. Jonathan S Myers3,4,
  3. Andrew Ines4,
  4. Alicia Jiang4,
  5. Kamran Rahmatnejad1,
  6. Tingting Zhan5,
  7. Benjamin E Leiby5,
  8. Sarah Hegarty5,
  9. Scott J Fudemberg3,4,
  10. Anand V Mantravadi3,4,
  11. Michael Waisbourd6,
  12. Jeffrey D Henderer7,
  13. Christine Burns1,
  14. Meskerem Divers1,
  15. Jeanne Molineaux1,
  16. Laura T Pizzi8,
  17. Ann P Murchison4,9,
  18. Jinan Saaddine10,
  19. Louis R Pasquale11,
  20. Julia A Haller4,12,
  21. L Jay Katz3,4
  1. 1 Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
  2. 2 Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
  3. 3 Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
  4. 4 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  5. 5 Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  6. 6 Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  7. 7 Ophthalmology, Temple University Hospital, Philadelphia, Pennsylvania, USA
  8. 8 School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
  9. 9 Emergency Department, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
  10. 10 Centers for Disease Control and Prevention, Division of Diabetes Translation, Vision Health Initiative, Atlanta, Georgia, USA
  11. 11 Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  12. 12 Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Lisa A Hark, Ophthalmology, Columbia University Irving Medical Center, New York, NY 10032, USA; lah112{at}cumc.columbia.edu

Abstract

Aims To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2).

Methods A primary care practice (PCP)–based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants’ local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis.

Results Of 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (±SD) of 60.6±11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2.

Conclusions This screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg.

Trial registration number NCT02390245.

  • Telemedicine
  • Glaucoma
  • Diagnostic tests/Investigation
  • Intraocular pressure
  • Public health

https://doi.org/10.1136/bjophthalmol-2018-313451

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    Footnotes

    • Contributors LAH had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This manuscript publication is approved by all authors and by the responsible authorities where the work was carried out. LAH has obtained written permission to include the names of all individuals included in the AcknowledgEment section and confirms that such permission has been obtained in the Authorship Form. Concept and design: LAH, JSM, LJK, JAH, LTP, BEL. Acquisition, analysis or interpretation of data: LAH, JM, CB, MD, AVM, AI, AJ, KR, SJF, LTP, AVM, MW. Drafting of manuscript: LAH, JSM, LJK, JAH, BEL, SH, TZ, JH, MW, AI, AJ, KR, LRP, LTP, JS. Critical revision of the manuscript for important intellectual content: LAH, JSM, LJK, LRP, JAH, LTP, BEL, JS. Statistical analysis: BEL, TZ, SH. Obtained funding: LAH, JSM, LJK, JAH. Administrative, technical or material support: JM, CB, MD.

    • Funding This study was supported by the United States Centers for Disease Control and Prevention (CDC) (Cooperative Agreement: U01 DP005127). The United States Centers for Disease Control and Prevention provided funding for this Cooperative Agreement and ongoing advice about the study implementation. This manuscript was internally reviewed and cleared for submission by the CDC to disseminate the findings.

    • Competing interests JSM: Grant/Research Support: Allergan (Madison, NJ), Aerie Pharmaceuticals (Bedminster Township, NJ), Diopsys (Montville, NJ), Haag-Streit (Bern, Switzerland), Heidelberg Engineering (Heidelberg, Germany), Alcon/Novartis (Sinking Spring, PA), Glaukos (San Clemente, CA); Consultant/Advisory Board: Allergan (Madison, NJ), Alcon (Sinking Spring, PA), Aerie Pharmaceuticals (Bedminster Township, NJ), Glaukos, Inotek (Lexington, MA), MicroOptx (Minneapolis, MN); Speakers List: Aerie, Allergan (Madison, NJ), Alcon (Sinking Spring, PA). SJF: Consulting and Speaking: Allergan (Madison, NJ) and Novartis (Sinking Spring, PA); Consultant: Aerie Pharmaceuticals (Bedminster Township, NJ). AVM: Consulting and Speaking: Glaukos (San Clemente, CA); Consultant: Allergan (Madison, NJ) and Gore Medical (Flagstaff, Arizona). LRP: Grant/Research Support: NEI, Bethesda, MD; Advisory Board for Eyenovia, NY, NY; Consultant for Bausch+Lomb, Inc. (Bridgewater, NJ). JAH: Grant/Research Support: ThromboGenics (Iselin, NJ); Consultant: Janssen (Raritan, NJ), Merck (Kenilworth, NJ), Novartis (East Hanover, NJ), KalVista (Cambridge, MA), Spark Therapeutics (Philadelphia, PA), Lowy Medical Research Institute (La Jolla, CA); Board Member: Celgene Corporation (Summit, NJ). LJK: Grant/Research Support: Allergan (Madison, NJ), Diopsys (Montville, NJ), Heidelberg Engineering (Heidelberg, Germany), Zeiss (Oberkochen, Germany); Consultant/Advisory Board: Allergan (Madison, NJ), Alcon (Sinking Spring, PA), Glaukos (San Clemente, CA), Aerie Pharmaceuticals (Bedminster Township, NJ), Diopsys (Montville, NJ), Mati Therapeutics (Austin, Texas), Aerpio Therapeutics (Blue Ash, OH); Speakers List: Allergan (Madison, NJ), Alcon (Sinking Spring, PA), Glaukos (San Clemente, CA), Bausch+Lomb (Rochester, NY), Aerie Pharmaceuticals (Bedminster Township, NJ); Stock Shareholder: Glaukos (San Clemente, CA), Mati Therapeutics (Austin, TX), Aerie Pharmaceuticals (Bedminster Township, NJ); Chief Medical Officer: Glaukos (San Clemente, CA).

    • Patient consent for publication Obtained.

    • Ethics approval The study had approval of the Wills Eye Hospital Institutional Review Board (#14-441) and was conducted in accordance with the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data will be made available upon request.

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