Detection of glaucoma-like optic discs in a diabetes teleretinal program.
BACKGROUND
Glaucoma is typically an insidious-onset disease with serious visual consequences that has been positively linked to diabetes mellitus (DM) in several studies. We assessed the sensitivity and specificity of a diabetes teleretinal program to identify the glaucoma-suspicious optic disc.


METHODS
Outpatients with DM (N = 1,644) presenting to Veterans Affairs ambulatory clinics participated in a nonmydriatic digital retinal imaging (NMDRI) program. Technicians transmitted digital retinal images electronically to readers for grading and eye care recommendations. Patients were referred for ophthalmic care based on the level of diabetic retinopathy and other ocular findings, including optic nerve changes suspicious for glaucoma. We retrospectively reviewed the electronic medical records of patients labeled as glaucoma suspects (N = 175) and compared them with those of patients from the same imaging pool who were not regarded as glaucoma suspects (N = 175). Ophthalmic data obtained from a comprehensive eye examination after digital retinal imaging was used to determine which patients met predefined criteria for the optic disc suggestive of glaucoma.


RESULTS
Assessment of clinical data obtained after NMDRI found that 103 of 175 (59%) glaucoma suspects had glaucoma-suspicious optic discs. In the comparison group, only 7 of 175 (4%) had glaucoma-suspicious optic discs.


CONCLUSIONS
Although specificity was high (96%), modifications in diabetes teleretinal imaging programs are needed to improve the sensitivity of detecting the optic disc that is suspicious for glaucoma.
Pasquale
Louis R
LR
Ocular Telehealth Center, VA Boston Healthcare System-Jamaica Plain Campus, Jamaica Plain, Massachusetts 02130, USA. Louis.Pasquale@va.gov
Asefzadeh
Baharak
B
Dunphy
Robert W
RW
Fisch
Barry M
BM
Conlin
Paul R
PR
D000368:Aged; D003936:Diagnosis, Computer-Assisted; D005260:Female; D005654:Fundus Oculi; D005901:Glaucoma / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000592:standards