title: Accuracy of a technology-assisted eye exam in evaluation of referable diabetic retinopathy and concomitant ocular diseases.
abstract: OBJECTIVE
  Digital retinal imaging using store-and-forward technology is used to screen for diabetic retinopathy (DR). Its usefulness in detecting non-diabetic eye diseases is uncertain. We determined the level of agreement between teleretinal imaging supplemented with visual acuity and intraocular pressure (IOP) measurements (ie, technology-assisted eye (TAE) exam) and a comprehensive eye exam in evaluation for DR and non-diabetic ocular conditions.
  
  
  METHODS
  We conducted a prospective, observational study with two parallel evaluations. Patients with diabetes (n=317) had a TAE exam and a comprehensive eye exam on the same day. A subset of participants with normal baseline exams (n=72) had follow-up exams 1 year later. We measured the level of agreement for referable ocular findings.
  
  
  RESULTS
  Agreement for referable ocular findings was moderate (n=389, agreement: 77%; κ: 0.55), due in part to ungradable exams (22%). However, about half of the ungradable exams had findings that warranted referral. There was substantial agreement for follow-up exams (n=72, agreement: 93%; κ: 0.63). Among all gradable exams (n=303), the TAE exam had 86% sensitivity and 84% specificity for referable ocular findings, with high agreement (≥94%) for DR and other major ocular diagnoses.
  
  
  CONCLUSIONS
  There was moderate-to-substantial agreement between a TAE exam and a comprehensive eye exam for referable ocular findings in patients with diabetes. Ungradable exams were a frequent marker of ocular pathology. Teleretinal imaging may be a useful evaluation for both diabetic and non-diabetic ocular conditions.
authors.affiliation: Department of Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Conlin
authors.affiliation: Department of Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA New England College of Optometry, Boston, Massachusetts, USA.
authors.forename: Baharak
authors.initials: B
authors.lastname: Asefzadeh
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pasquale
authors.affiliation: Department of Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA New England College of Optometry, Boston, Massachusetts, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Selvin
authors.affiliation: Department of Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lamkin
authors.affiliation: Department of Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA New England College of Optometry, Boston, Massachusetts, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Cavallerano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005128:Eye Diseases / Q000175:diagnosis*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology
keywords: Imaging; Telemedicine