title: A pilot trial of tele-ophthalmology for diagnosis of chronic blurred vision.
abstract: We evaluated the accuracy of tele-ophthalmology in diagnosing the major causes of chronic blurring of vision. Thirty consecutive patients attending a primary eye-care facility in Singapore (the Ang Mo Kio Polyclinic, AMKP) with the symptom of chronic blurred vision were recruited. An ophthalmic technician was trained to perform Snellen acuity; auto-refraction; intraocular pressure measurement; red-colour perimetry; video recordings of extraocular movement, cover tests and pupillary reactions; and anterior segment and fundus photography. Digital information was transmitted to a tertiary hospital in Singapore (the Tan Tock Seng Hospital) via a tele-ophthalmology system for teleconsultation with an ophthalmologist. The diagnoses were compared with face-to-face consultation by another ophthalmologist at the AMKP. A user experience questionnaire was administered at the end of the consultation. Using face-to-face consultation as the gold standard, tele-ophthalmology achieved 100% sensitivity and specificity in diagnosing media opacity (n = 29), maculopathy (n = 23) and keratopathy (n = 30) of any type; and 100% sensitivity and 92% specificity in diagnosing optic neuropathy of any type (n = 24). The majority of the patients (97%) were satisfied with the tele-ophthalmology workflow and consultation. The tele-ophthalmology system was able to detect causes of chronic blurred vision accurately. It has the potential to deliver high-accuracy diagnostic eye support to remote areas if suitably trained ophthalmic technicians are available.
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore. johnsontch@gmail.com
authors.forename: Johnson Choon Hwai
authors.initials: JC
authors.lastname: Tan
authors.forename: Eugenie Wei Ting
authors.initials: EW
authors.lastname: Poh
authors.forename: Sanjay
authors.initials: S
authors.lastname: Srinivasan
authors.forename: Tock Han
authors.initials: TH
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000379:methods*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D019114:Remote Consultation / Q000592:standards; D012680:Sensitivity and Specificity; D012846:Singapore; D014786:Vision Disorders / Q000175:diagnosis*; D014792:Visual Acuity