title: Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis.
abstract: OBJECTIVE
  To determine the feasibility of remote diagnostic screening for cytomegalovirus (CMV) retinitis among HIV patients in northern Thailand.
  
  
  METHODS
  Prospective, observational cross-sectional study.
  
  
  METHODS
  One hundred eighty-two eyes from 94 consecutive patients with HIV seen in 2008 and 2009 at a tertiary university-based medical center were photographed using a digital retinal camera. Individual and composite images were uploaded to a secure web site. Three expert graders accessed the electronic images and graded each image for signs of CMV retinitis. Results of remote expert grading were compared with on-site patient examination by local expert ophthalmologists.
  
  
  RESULTS
  On-site ophthalmologists diagnosed CMV retinitis in 89 (48.9%) of 182 eyes. Trained ophthalmic photographers obtained digital retinal images for all 182 eyes. As compared with the on-site examinations, the sensitivity for detecting CMV retinitis by remote readers using composite retinal images ranged from 89% to 91%. The specificity for detecting CMV retinitis by remote readers ranged from 85% to 88%. Intrarater reliability was high, with each grader achieving a κ value of 0.93. Interrater reliability among the 3 graders also was high, with a κ value of 0.86.
  
  
  CONCLUSIONS
  Remote diagnostic screening for CMV retinitis among HIV-positive patients may prove to be a valuable tool in countries where the burden of HIV exceeds the capacity of the local eye care providers to screen for ocular opportunistic infections.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand.
authors.forename: Somsanguan
authors.initials: S
authors.lastname: Ausayakhun
authors.forename: Alison H
authors.initials: AH
authors.lastname: Skalet
authors.forename: Choeng
authors.initials: C
authors.lastname: Jirawison
authors.forename: Sakarin
authors.initials: S
authors.lastname: Ausayakhun
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.forename: Claire
authors.initials: C
authors.lastname: Khouri
authors.forename: Khang
authors.initials: K
authors.lastname: Nguyen
authors.forename: Partho S
authors.initials: PS
authors.lastname: Kalyani
authors.forename: David
authors.initials: D
authors.lastname: Heiden
authors.forename: Gary N
authors.initials: GN
authors.lastname: Holland
authors.forename: Todd P
authors.initials: TP
authors.lastname: Margolis
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D017726:Cytomegalovirus Retinitis / Q000145:classification / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019114:Remote Consultation / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013785:Thailand