title: The Muranga Teleophthalmology Study: Comparison of Virtual (Teleglaucoma) with in-Person Clinical Assessment to Diagnose Glaucoma.
abstract: OBJECTIVE
  While the effectiveness of teleophthalmology is generally accepted, its ability to diagnose glaucomatous eye disease remains relatively unknown. This study aimed to compare a web-based teleophthalmology assessment with clinical slit lamp examination to screen for glaucoma among diabetics in a rural African district.
  
  
  METHODS
  Three hundred and nine diabetic patients underwent both the clinical slit lamp examination by a comprehensive ophthalmologist and teleglaucoma (TG) assessment by a glaucoma subspecialist. Both assessments were compared for any focal glaucoma damage; for TG, the quality of photographs was assessed, and vertical cup-to-disk ratio (VCDR) was calculated in a semi-automated manner. In patients with VCDR > 0.7, the diagnostic precision of the Frequency Doubling Technology (FDT) C-20 screening program was assessed.
  
  
  RESULTS
  Of 309 TG assessment photos, 74 (24%) were deemed unreadable due to media opacities, patient cooperation, and unsatisfactory photographic technique. While the identification of individual optic nerve factors showed either fair or moderate agreement, the ability to diagnose glaucoma based on the overall assessment showed moderate agreement (Kappa [κ] statistic 0.55% and 95% confidence interval [CI]: 0.48-0.62). The use of FDT to detect glaucoma in the presence of disc damage (VCDR > 0.7) showed substantial agreement (κ statistic of 0.84 and 95% CI 0.79-0.90). A positive TG diagnosis of glaucoma carried a 77.5% positive predictive value, and a negative TG diagnosis carried an 82.2% negative predicative value relative to the clinical slit lamp examination.
  
  
  CONCLUSIONS
  There was moderate agreement between the ability to diagnose glaucoma using TG relative to clinical slit lamp examination. Poor quality photographs can severely limit the ability of TG assessment to diagnose optic nerve damage and glaucoma. Although further work and validation is needed, the TG approach provides a novel, and promising method to diagnose glaucoma, a major cause of ocular morbidity throughout the world.
authors.affiliation: Department of Ophthalmology, Aga Khan University Nairobi, Kenya.
authors.forename: Dan
authors.initials: D
authors.lastname: Kiage
authors.forename: Irfan N
authors.initials: IN
authors.lastname: Kherani
authors.forename: Stephen
authors.initials: S
authors.lastname: Gichuhi
authors.forename: Karim F
authors.initials: KF
authors.lastname: Damji
authors.forename: Muindi
authors.initials: M
authors.lastname: Nyenze
mesh_terms: D000328:Adult; D000368:Aged; D005189:False Positive Reactions; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000379:methods*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography / Q000379:methods; D011237:Predictive Value of Tests; D017216:Telemedicine / Q000379:methods*; D014584:User-Computer Interface
keywords: Glaucoma; Optic Neuropathy; Slit Lamp Examination; Teleglaucoma; Teleophthalmology