Diagnostic accuracy of a remote eye exam in measuring refractive errors and detecting cataract, glaucoma, and diabetic retinopathy

Abstract

PorpuseApproximately 2.2 billion people worldwide have some type of visual impairment and among these, many could have been avoided or solved if adequate care had been provided in a timely manner. In these cases, telemedicine can assist in solving the problems of many ophthalmological conditions by providing support, performing screening, telediagnosis or supervision of distant appointments. The use of telemedicine for eye health is well established for some eye diseases, such as diabetic retinopathy, macular diseases and strabismus, however, there is a lack of information on diagnostic accuracy for other ophthalmological pathologies prevalent in the world population, such as refractive errors. To evaluate the reliability of the diagnosis made through teleophthalmology, using the ophthalmologist’s face-to-face diagnosis as the gold standard.MethodsA diagnostic accuracy study was carried out, with 216 patients assessed by the TeleOftalmo project who underwent eye examinations both on-site and through telemedicine. The patients underwent refraction tests, intraocular pressure measurement, photodocumentation in the slit-lamp and subjective refraction using the visual acuity screen and the digital refractor.ResultsThe conditions evaluated were refractive errors, cataracts, diabetic retinopathy and suspected glaucoma. Kappa values, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Approximately, 61.6% of the sample were women, with mean age of 47 years old. Kappa values show strong reliability regarding the diagnosis of cataracts (k = 0.86) and diabetic retinopathy (k = 0.79). Regarding refractive errors and suspected glaucoma, the kappa values were considered moderate (k = 0.598 and 0.478, respectively).ConclusionThe use of telemedicine has shown favorable results regarding the diagnosis of refractive errors, cataracts and diabetic retinopathy, as well as moderate reliability for suspected glaucoma.