title: The effectiveness of teleglaucoma versus in-patient examination for glaucoma screening: a systematic review and meta-analysis.
abstract: BACKGROUND
  Glaucoma is the leading cause of irreversible visual impairment in the world affecting 60.5 million people worldwide in 2010, which is expected to increase to approximately 79.6 million by 2020. Therefore, glaucoma screening is important to detect, diagnose, and treat patients at the earlier stages to prevent disease progression and vision loss. Teleglaucoma uses stereoscopic digital imaging to take ocular images, which are transmitted electronically to an ocular specialist. The purpose is to synthesize literature to evaluate teleglaucoma, its diagnostic accuracy, healthcare system benefits, and cost-effectiveness.
  
  
  METHODS
  A systematic search was conducted to help locate published and unpublished studies. Studies which evaluate teleglaucoma as a screening device for glaucoma were included. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. The improvements to healthcare service quality and cost data were assessed.
  
  
  RESULTS
  Of 11237 studies reviewed, 45 were included. Our results indicated that, teleglaucoma is more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The relative odds of a positive screen test in glaucoma cases are 18.7 times more likely than a negative screen test in a non-glaucoma cases. Additionally, the mean cost for every case of glaucoma detected was $1098.67 US and of teleglaucoma per patient screened was $922.77 US.
  
  
  CONCLUSIONS
  Teleglaucoma can accurately discriminate between screen test results with greater odds for positive cases. It detects more cases of glaucoma than in-person examination. Both patients and the healthcare systems benefit from early detection, reduction in wait and travel times, increased specialist referral rates, and cost savings. Teleglaucoma is an effective screening tool for glaucoma specifically for remote and under-services communities.
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada.
authors.forename: Sera-Melisa
authors.initials: SM
authors.lastname: Thomas
authors.forename: Maya M
authors.initials: MM
authors.lastname: Jeyaraman
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada.
authors.forename: Maya
authors.initials: M
authors.lastname: Jeyaraman
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, London, Canada.
authors.forename: William G
authors.initials: WG
authors.lastname: Hodge
authors.affiliation: Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, London, Canada.
authors.forename: Cindy
authors.initials: C
authors.lastname: Hutnik
authors.affiliation: Allyn and Betty Taylor Library, Western University, London, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Costella
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, London, Canada.
authors.forename: Monali S
authors.initials: MS
authors.lastname: Malvankar-Mehta
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics*; D003941:Diagnostic Techniques, Ophthalmological; D005901:Glaucoma / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D006801:Humans; D008403:Mass Screening; D010808:Physical Examination; D017216:Telemedicine