Telemedicine may provide an accurate method for glaucoma detection compared with an in-person examination. New research, conducted at the University of Alabama at Birmingham, compared diagnoses made via telemedicine, in-person ophthalmologist examination, and in-person optometrist examination.
The cross-sectional study, published in the Journal of Glaucoma, included 200 eyes from 100 patients, with a median age of 66 years (interquartile range: 59-72). The study population comprised 40% males and 62% white patients. Comorbidities were prevalent, with 63% having hypertension, 33% having diabetes, and 4% reporting migraines. A family history of glaucoma was reported by 34% of participants.
The study enrolled 50 new patients referred for glaucoma evaluation and 50 established patients without glaucoma. The study was conducted from January to September 2017.
The in-person ophthalmologist diagnosed glaucoma in 96 out of 200 eyes. Telemedicine reviewers diagnosed glaucoma in 97 (telemedicine ophthalmologist reviewer 1) and 102 (telemedicine ophthalmologist reviewer 2) eyes, with 71 eyes in agreement with the in-person ophthalmologist for each reviewer. The in-person optometrist diagnosed glaucoma in 103 eyes, with 70 eyes in agreement with the ophthalmologist.
The in-person ophthalmologist examination involved a comprehensive dilated eye exam, which included both structural and functional testing of the optic nerve. This is done using advanced diagnostic tools such as spectral domain optical coherence tomography, Humphrey visual field testing, and optic nerve photography.
The in-person optometrist examination similarly consisted of a dilated eye exam. In this case, the optometrist had access to the patient’s previous imaging and examination data but remained blinded to the ophthalmologist's diagnosis.
For the telemedicine review, two ophthalmologists independently assessed the structural and functional tests of the optic nerve. They also reviewed the patient’s demographic information, relevant risk factors, and examination data, all without knowledge of the in-person diagnoses.
Diagnoses were categorized as normal or glaucoma (including ocular hypertension, glaucoma suspect, open-angle glaucoma, normal-tension glaucoma, other types of glaucoma, or other optic nerve problems). Agreement was assessed using Cohen's unweighted kappa statistic.
The in-person ophthalmologist, TMD1, and TMD2 all had fellowship training in glaucoma, while the optometrist practiced primary eye care in an academic setting.
The study authors noted several limitations, including the inability to compare agreement for subcategories of glaucoma diagnoses due to sample size constraints and the lack of longitudinal follow-up. Additionally, the study was based on diagnoses from a single in-person ophthalmologist and optometrist, potentially limiting generalizability.
For future research, the researchers suggested exploring the use of more objective diagnostic criteria and the integration of artificial intelligence in analyzing automated perimetry and optic nerve thickness imaging to potentially improve the reliability of telemedicine-based glaucoma diagnosis.
The study was supported by several sources, including the Centers for Disease Control and Prevention, National Eye Institute, EyeSight Foundation of Alabama, and Research to Prevent Blindness. The authors declared no conflict of interest.
