title: Detection of retinal lesions after telemedicine transmission of digital images.
abstract: OBJECTIVE
  To assess whether loss of image resolution or colour and subsequent telemedicine transmission of digital images affects the accuracy of retinal lesion detection by ophthalmologists when compared with the original transparencies.
  
  
  METHODS
  Fifteen ophthalmologists of different experience independently scored 11 retinal images for pathological signs. The images were presented as either transparencies or colour and monochrome digital images, which had been transmitted via telephone lines to a geographically remote location. One patient's eye was also imaged using scanning laser ophthalmosocopy (SLO) which produced a dynamic black and white digital image. ANOVA analysis was performed.
  
  
  RESULTS
  Total scores were higher for transparencies than colour (p = 0.0003) or black and white digital images (p = 0.00006). Expert observers (n = 5) considered separately showed no significant difference of accuracy between transparencies and either colour digital (p = 0.09) or monochrome digital images (p = 0.11). Experts were better than trainees at detecting pathology from less familiar images: total score (p = 0.02), colour digital (p = 0.03), monochrome digital (p = 0.02) and SLO images (p = 0.004).
  
  
  CONCLUSIONS
  Experienced observers can identify sight-threatening retinal pathology from poorer-resolution digital images that have been transmitted by telemedicine. They can also adapt to viewing less familiar images such as black and white digital or SLO images.
authors.affiliation: Department of Ophthalmology, GKT Schools, London, UK. HelenLCook@aol.com
authors.forename: H L
authors.initials: HL
authors.lastname: Cook
authors.forename: G L
authors.initials: GL
authors.lastname: Heacock
authors.forename: M R
authors.initials: MR
authors.lastname: Stanford
authors.forename: J
authors.initials: J
authors.lastname: Marshall
mesh_terms: D000704:Analysis of Variance; D002983:Clinical Competence; D003116:Color; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007834:Lasers; D009887:Ophthalmoscopy / Q000379:methods; D010781:Photography; D012164:Retinal Diseases / Q000175:diagnosis*; D017216:Telemedicine