Teleophthalmology: improving patient outcomes?

Figures & data

Table 1 Major findings of review articles on tele-ROP screening using wide-field digital imaging of premature infant retina

Study	Main objective	Key finding
Richter et al^Citation27	1) Compared six studies to find specificity and sensitivity to identify any stage of ROP.	1) Sensitivity 76% to 97% (except two studies, which reported 46% and 60%). Specificity 89% to 100% (except one study, which reported specificity ranges from 49% to 96%).
	2) Compared five studies reporting sensitivities and specificities to diagnose moderate-to-severe ROP.	2) Sensitivity 71% to 100% (except one study, which reported 57%). Specificity 81% to 100%.
Vinekar et al^Citation10	Comparison of real-world tele-ROP programs worldwide. Seven studies included.	Sensitivity ranges from 90% to 100%.
Weaver DT^Citation18	The study reviewed available evidences of digital retinal imaging via telemedicine to examine reliability, accessibility, and cost efficacy in ROP screening (including current practice).	Overall, the report concluded that digital retinal photography has high accuracy for the detection of clinically significant ROP, and additionally, provides potential advantages through objective documentation of exam findings, improved recognition of disease progression by comparison with prior photographs, and the creation of image libraries for education and research.
Kandasamy et al^Citation5	The study reviews the feasibility of using nonophthalmologist staff for tele-ROP screening, efficacy of digital imaging of infant retina in ROP diagnosis as part of telemedicine, and cost-effectiveness of tele-ROP screening.	ROP diagnosis using telemethod. Sensitivity ranges: 0.46–0.97. Specificity ranges: 0.89–1. Interobserver reliability (κ) ranged from 0.67 to 0.89.
		Sensitivity: 100%, specificity: 97.9%, PPV: 84.6%, NPV: 100%.
		Cost saving is better with telemedicine than with bedside BIO for ROP management.
		Experts are required for accurate image analysis when compared with image analysis by trained nonexperts.
Fierson et al^Citation2	This systematic review focuses on available literature on tele-ROP using digital imaging and highlights practical and risk management considerations that should be used when tele-ROP screening is used.	A total of 486 studies retrieved, eleven studies selected for detailed analysis and classified as level 1, 2, and 3 studies.
		Level 1 studies (N=8).
		ROP Zone 1 any stage with disease/Zone 1 stage 3/Zone 11 stage 2 or 3 with plus disease.
		Mean sensitivities 92.8% specificity 94%.
		Level 3 studies (N=3) from real-world tele-ROP programs reported high accuracy to detect clinically significant ROP through remote site interpretation of wide-angle retinal image.
		Moderate (levels 2 and 3) quality supports the use of retinal imaging to identify patients with clinically significant or referral-warranted ROP for ophthalmic evaluation and management.
		However, the current imaging system collects less information than what is required to fully stage the disease based on international classification of ROP.

Abbreviations: ROP, retinopathy of prematurity; PPV, positive predictive value; NPV, negative predictive value; BIO, binocular indirect ophthalmoscopy.

Table 2 Patient satisfaction in teleophthalmology services

Study	Teleophthalmology mode/number of subjects surveyed	Satisfaction
Paul et al^Citation55	Rural mobile teleophthalmology unit/348 subjects (age range: 18–83 years)	99.8%
Kumar et al^Citation56	Remote teleophthalmology center/118 subjects	98%
Tuulonen et al^Citation46	Real-time interactive teleconsultation at rural primary care center compared with face-to-face clinical examination	Equal satisfaction between the two groups. 96% of the telegroup preferred follow-up examination via teleconsultation.
Court et al^Citation57	Virtual glaucoma clinic (135 patients) compared with control group of normal clinic patients (100 patients)	High satisfaction in both the clinics (4.5/5 and 4.6/5). Reported high awareness among virtual clinic patients
Sreelatha et al^Citation58	VA testing in remote portal compared with face-to-face examination	87% of the patients reported high satisfaction with tele VA measurement
Kurji et al^Citation59	DR screening in multidisciplinary diabetic clinic (57 subjects): assessment done for patient preference between teleophthalmology and face-to-face ophthalmologist evaluation	88% satisfied with teleophthalmology services. Patients preferred the teleophthalmology option for future screenings. Convenience, reduced examination time, and visualization of patient’s own retina were the support factors.

Abbreviations: VA, visual acuity; DR, diabetic retinopathy.

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VinekarAJayadevCMangaleshSShettyBVidyasagarDRole of tele-medicine in retinopathy of prematurity screening in rural outreach centers in India – A report of 20,214 imaging sessions in the KIDROP programSemin Fetal Neonatal Med2015 pii: S1744-165X(15)00053-0

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WeaverDTTelemedicine for retinopathy of prematurityCurr Opin Ophthalmol20132442543123872819

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KandasamyYSmithRWrightIHartleyLUse of digital retinal imaging in screening for retinopathy of prematurityJ Paediatr Child Health2013491E1E522970982

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FiersonWMCaponeAJrAmerican Academy of Pediatrics Section on OphthalmologyAmerican Academy of Ophthalmology, American Association of Certified OrthoptistsTelemedicine for evaluation of retinopathy of prematurityPediatrics20151351e238e25425548330

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PaulPGRamanRRaniPKDeshmukhHSharmaTPatient satisfaction levels during teleophthalmology consultation in rural South IndiaTelemed J E Health200612557157817042711

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KumarSTay-KearneyMLConstableIJYogesanKInternet based ophthalmology service: impact assessmentBr J Ophthalmol200589101382138316170148

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TuulonenAOhinmaaTAlankoHIHyytinenPJuutinenAToppinenEThe application of teleophthalmology in examining patients with glaucoma: a pilot studyJ Glaucoma19998636737310604295

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CourtJHAustinMWVirtual glaucoma clinics: patient acceptance and quality of patient education compared to standard clinicsClin Ophthalmol2015974574925987832

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SreelathaOKRameshSVJoseJDevassyMSrinivasanKVirtually controlled computerised visual acuity screening in a multilingual Indian populationRural Remote Health2014143290825190644

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KurjiKKiageDRudniskyCJDamjiKFImproving diabetic retinopathy screening in Africa: patient satisfaction with teleophthalmology versus ophthalmologist-based screeningMiddle East Afr J Ophthalmol2013201566023580853

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