@article {Stewartbjophthalmol-2020-318385, author = {Carly Stewart and Josephine Coffey-Sandoval and Mark W Reid and Tiffany C Ho and Thomas C Lee and Sudha Nallasamy}, title = {Reliability of telemedicine for real-time paediatric ophthalmology consultations}, elocation-id = {bjophthalmol-2020-318385}, year = {2021}, doi = {10.1136/bjophthalmol-2020-318385}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background/aims To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions.Methods Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0{\textendash}17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was \<1.5\% for management plan or \<15\% for diagnosis discrepancies.Results 210 patients participated in 348 examinations. 131 (62.4\%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98{\textendash}1.00) and disease categorisation (kappa=0.94{\textendash}1.00) (p\<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5\%) and would participate in another in the future (97.1\%).Conclusion Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology.}, issn = {0007-1161}, URL = {https://bjo.bmj.com/content/early/2021/03/15/bjophthalmol-2020-318385}, eprint = {https://bjo.bmj.com/content/early/2021/03/15/bjophthalmol-2020-318385.full.pdf}, journal = {British Journal of Ophthalmology} }