title: Prospective evaluation of teleophthalmology in screening and recurrence monitoring of neovascular age-related macular degeneration: a randomized clinical trial.
abstract: OBJECTIVE
  Teleophthalmology has the potential to reduce costs and inconveniences associated with frequent patient visits. Evaluating teleophthalmology in the management of age-related macular degeneration (AMD) will allow for future implementation of this technology.
  
  
  OBJECTIVE
  To evaluate teleophthalmology as a tool for the screening and monitoring of neovascular AMD.
  
  
  METHODS
  Prospective, randomized clinical trial that included 106 referral eyes for suspected neovascular AMD and 63 eyes with stable neovascular AMD. New referrals for patients with suspected neovascular AMD and patients with stable neovascular AMD were randomized into either routine or teleophthalmologic groups. In the routine group, patients received clinical assessment and diagnostic imaging at a tertiary hospital-based retina clinic. In the teleophthalmologic group, patients received basic examination and diagnostic imaging at a stand-alone teleophthalmologic site, where patient information and imaging studies were acquired and electronically sent over to tertiary hospital-based retina specialists. Patients in the teleophthalmologic group were called back to the tertiary treatment center if the teleophthalmologic data set suggested pathology or was inconclusive for diagnosis.
  
  
  METHODS
  Patient wait times for diagnosis and/or treatment, referral accuracy, and visual outcome.
  
  
  RESULTS
  For neovascular AMD screening, the average referral-to-diagnostic imaging time was 22.5 days for the teleophthalmologic group and 18.0 days for the routine group, for a difference of 4.5 days (95% CI, 11.8 to -2.8 days; P = .23). The average diagnostic imaging to treatment time was 16.4 days for the teleophthalmologic group and 11.6 days for the routine group, for a difference of 4.8 days (95% CI, 10.7 to -1.1 days; P = .11). For neovascular AMD monitoring, the average recurrence to treatment time was shorter for the routine group (0.04 days) compared with 13.6 days for the teleophthalmologic group, for a difference of -13.5 days (95% CI, -18.2 to -9.0 days; P < .01). There was no difference identified between end-of-study visual acuities in the 2 groups (P = .99).
  
  
  CONCLUSIONS
  A delay of referral to treatment time could not be identified when comparing teleophthalmologic screening for suspected neovascular AMD with retinal specialist-based screening. Teleophthalmologic monitoring for neovascular AMD recurrence resulted in longer wait times for treatment reinitiation, but no adverse visual outcomes were identified.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier:NCT01581606.
authors.affiliation: Ivey Eye Institute, Western University, London, Ontario, Canada.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.affiliation: Ivey Eye Institute, Western University, London, Ontario, Canada.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Powell
authors.affiliation: Ivey Eye Institute, Western University, London, Ontario, Canada.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Hooper
authors.affiliation: Ivey Eye Institute, Western University, London, Ontario, Canada.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Sheidow
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D009885:Ophthalmology / Q000379:methods*; D009887:Ophthalmoscopy; D017060:Patient Satisfaction; D011446:Prospective Studies; D012008:Recurrence; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D015351:Vision Screening / Q000379:methods*; D014792:Visual Acuity; D014850:Waiting Lists; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000628:therapy