Comprehensive Primary Eye Care: A Comparison Between an In-Person Eye Exam and a Tele-Eye Care Exam

Abstract

Introduction

Proper access to primary eye care is essential in addressing vision impairment, and tele-eye care examinations are a promising solution that could facilitate this access in many rural or remote areas. Even though remote eye exams are becoming increasingly frequent, comprehensive tele-eye care exams are still limited by the lack of published data. The aim of this study is to compare a comprehensive tele-eye care exam with a gold standard in-person primary eye care exam with an emphasis on refractive measurements, ocular health assessment, confidence level of the eye care providers and patient satisfaction.

Methods

Sixty-six participants underwent two comprehensive eye exams performed by two eye care providers. One was a gold standard in-person exam, while the other was a remote exam performed by an eye care provider through videoconference. An overall patient satisfaction survey and a questionnaire for visual comfort with a trial frame from each modality were completed and the eye care providers scored their confidence level for each test. Exam results and diagnoses were compared between both modalities.

Results

Tele-refraction has a good to excellent agreement with in-person subjective refraction in terms of sphero-cylindrical power and best corrected visual acuity. There was no statistically significant difference for visual comfort between both modalities. The agreement between in-person and remote exams for ocular health assessment ranged from fair to almost perfect, but there was a low prevalence of ocular pathologies within the study sample. The confidence level of the eye care providers and patient satisfaction were statistically higher in-person.

Conclusion

Tele-eye care appears to be statistically and clinically non-inferior to in-person eye exams, especially for refraction, but the low prevalence of ocular pathologies somewhat limits the comparison of its efficacy for ocular health assessment. More studies on comprehensive tele-eye care exams are needed.

Keywords:

• primary eye care
• tele-eye care
• tele-ophthalmology
• tele-optometry
• tele-refraction

Acknowledgments

The authors would like to thank Fannie Brisson, OD, Anne-Marie Fontaine, OD, Claudelle Jolicoeur, OD, Emma Lamontagne, OD, Jolaine Primeau, OD, and Julien Leduc, final-year optometry student, for their precious help throughout this research project.

An abstract of this paper was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1–4, 2022, and virtually. This poster’s abstract was published in “Poster Abstracts” in Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1387 – A0083:

https://iovs.arvojournals.org/article.aspx?articleid=2782352

Another abstract of this paper was presented at the 2022 AAO Annual Meeting, held in San Diego, CA, October 25–31, 2022, in-person. The poster’s abstract was not published in a Journal but can be found online in the Past Meeting Abstract Archives:

https://aaopt.org/past-meeting-abstract-archives/?SortBy=ArticleAuthor&ArticleType=&ArticleYear=&Title=Comparison+of+Refractive+Outcomes+Between+a+Tele-Eye+Care+Comprehensive+Eye+Exam+and+a+Gold+Standard+In-Person+Eye+Exam&Abstract=&Authors=blais&Affiliation=&PROGRAMNUMBER=

Disclosure

Dr Nicolas Blais reports grants from Mitacs, Canadian Institutes of Health Research and IRIS The Visual Group, during the conduct of the study. The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Additional information

Funding

This study was supported by Mitacs and IRIS The Visual Group through the Mitacs Accelerate program. These sponsors were not involved in the stages from study design to submission of the paper.