Telemedical evaluation of ocular adnexa and anterior segment

Threlkeld, Anisa B.; Fahd, Tony; Camp, Matthew C.; Johnson, Maribeth H.

doi:10.1016/s0002-9394(98)00355-9

Cited by 29 publications

(28 citation statements)

References 2 publications

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“…38 We created a protocol based on the American Telemedicine Association guidelines 2 and other clinical trial protocols. 37–39 An opportunity exists to create standardized photography protocols for corneal diseases to serve as an image-based gold-standard. This standardization could open new avenues for image-based research in corneal disease, as has been done in numerous retina clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…We identified 16 publications related to remote imaging for anterior segment diseases reported in the literature. 39–54 The standard slit-lamp biomicroscope is the gold standard for corneal examination. Kumar and colleagues created a portable digital slit-beam device and, compared to a clinical examination, found that gross corneal signs were detected with modest to excellent sensitivity (67–100%), but subtle corneal signs, such as epitheliopathy, were not detected at all (sensitivity 0%).…”

Section: Discussionmentioning

confidence: 99%

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Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Woodward

Musch

Hood

et al. 2017

Cornea

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Purpose Corneal and anterior segment diseases cause the majority of urgent visits to eye-care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from two portable cameras for telemedicine purposes. Methods A prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A corneal specialist provided the gold-standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for presence of pathology. Accuracy to detect disease was compared to gold standard diagnosis, stratified by camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal). Results 198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54–71% for iTouch and 66–75% for Nidek, across graders; specificity ranged from 82–96% for iTouch and 91–98% for Nidek. Inter-grader reliability was moderate to strong (kappa ranges: 0.54–0.71 for iTouch; 0.75–0.76 for Nidek. Quality ratings were variable between graders. Conclusions External photographs taken by standard, non-enhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Woodward

Musch

Hood

et al. 2017

Cornea

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“…The optical characteristics of a given clinical sign may determine how well it is detected by the remote observer. Threlkeld et al 16 have suggested that clinical signs with low contrast cues for colour and depth are less reliably observed by TM compared to signs with high contrast cues for colour and depth. This may explain why vascularity and anterior chamber depth, which have high contrast for depth and colour, were more accurately assessed than bleb height and wall thickness, which frequently have relatively low contrast cues.…”

Section: Discussionmentioning

confidence: 99%

Evaluating clinical signs in trabeculectomized eyes

Crowston

Kirwan

Wells

et al. 2004

Eye

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Aim To evaluate interobserver agreement for clinical signs in trabeculectomized eyes when examined face-to-face with slit-lamp biomicroscopy (SL) or by remote examination using telemedicine (real-time remote video imaging; TM). Method A system for examining trabeculectomized eyes was devised and validated. A prospective randomized interobserver agreement study was then undertaken to compare standard SL biomicroscopy and TM. Remote examination was performed using a 384 kbps Sony 5100 videoconferencing system. Three ophthalmologists each examined 40 eyes of 40 patients, who had previously undergone trabeculectomy. In rotation, two examiners used SL biomicroscopy. The third examined the eye remotely by TM. Analysis was performed to determine the variability in clinical signs and the presence or absence of systematic bias between ophthalmologists and examination methods. Results High levels of agreement were observed for paired examinations by SL biomicroscopy (SL/SL) for bleb vascularity (score range 0-10) with no systematic bias. Paired examination by SL and TM (SL/TM) also showed good levels of agreement for bleb vascularity, although the spread of disagreement was wider (95% limits of agreement 2.57 vs 2.98 (P ¼ 0.054)). For anterior chamber depth, observers agreed within 710% of anterior chamber depth for 68% of eyes (SL/SL) and 51% of eyes (SL/TM) (P ¼ 0.68). Agreement was 'good' for wall thickness (j ¼ 0.6370.08), bleb height (j ¼ 0.6770.1), and the existence of bleb leak (j ¼ 0.6370.19), but poor for bleb morphology (j ¼ 0.2670.12). For the SL/TM comparison, agreement was fair for wall thickness (j ¼ 0.3970.13), poor for bleb height (j ¼ 0.1770.12), good for bleb leak (j ¼ 0.5670.19), and fair for bleb morphology (j ¼ 0.3170.12). Microcysts were not reliably detected using either technique. Conclusion SL biomicroscopy and TM telemedicine examination may permit reliable clinical assessment of trabeculectomized eyes. However, remote examination with TM is more limited with respect to assessing bleb height and bleb wall thickness. The assessment of bleb morphology and microcysts was unreliable with both instruments. We propose that TM examination of trabeculectomized eyes appears safe and appropriate in situations where face-to-face examination by an ophthalmologist is not practical.

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“…For instance, the sensitivity of detecting corneal pathologies, particularly corneal scars, using portable cameras (with 5.0 megapixels) was not adequate for tele-health application ( Woodward et al, 2017 ). In addition, teleophthalmology evaluation may fail to detect subtle signs such as corneal oedema and anterior chamber inflammation (cells and flare) that may be only detectable with high-resolution, high-contrast and dynamic assessment ( Threlkeld et al, 1999 ; Smith et al, 2003 ), particularly when the high-quality images/videos are required to be compressed before being transferred electronically. These issues highlight the importance of disease selection in when establishing a tele-health programme.…”

Section: Challenges For Clinical Implementationsmentioning

confidence: 99%

Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective

Liu

Ting

et al. 2021

Progress in Retinal and Eye Research

401

273

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The simultaneous maturation of multiple digital and telecommunications technologies in 2020 has created an unprecedented opportunity for ophthalmology to adapt to new models of care using tele-health supported by digital innovations. These digital innovations include artificial intelligence (AI), 5th generation (5G) telecommunication networks and the Internet of Things (IoT), creating an inter-dependent ecosystem offering opportunities to develop new models of eye care addressing the challenges of COVID-19 and beyond. Ophthalmology has thrived in some of these areas partly due to its many image-based investigations. Tele-health and AI provide synchronous solutions to challenges facing ophthalmologists and healthcare providers worldwide. This article reviews how countries across the world have utilised these digital innovations to tackle diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, refractive error correction, cataract and other anterior segment disorders. The review summarises the digital strategies that countries are developing and discusses technologies that may increasingly enter the clinical workflow and processes of ophthalmologists. Furthermore as countries around the world have initiated a series of escalating containment and mitigation measures during the COVID-19 pandemic, the delivery of eye care services globally has been significantly impacted. As ophthalmic services adapt and form a “new normal”, the rapid adoption of some of telehealth and digital innovation during the pandemic is also discussed. Finally, challenges for validation and clinical implementation are considered, as well as recommendations on future directions.

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Telemedical evaluation of ocular adnexa and anterior segment

Cited by 29 publications

References 2 publications

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Evaluating clinical signs in trabeculectomized eyes

Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective

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