title: Telemedicine for ophthalmic consultation services: use of a portable device and layering information for graders.
abstract: Introduction We compared remote, image-based patient consultations to in-person consultations at emergency department and inpatient hospital settings. Methods Patients evaluated by the ophthalmic consultation services (gold standard) were imaged over a two-week period. A trained study coordinator took anterior segment photographs (AS) and posterior segment photographs (PS) with a portable camera (PictorPlus, Volk Optical, Cleveland, OH). Ophthalmologists (graders) determined photograph quality, presence of pathology, and their confidence in disease detection. At a separate session, graders reassessed photographs accompanied by a one-sentence summary of demographics and chief complaint (CHx). We computed accuracy and reliability statistics. Results We took AS photographs of 24 eyes of 15 patients and PS photographs of 39 eyes of 20 patients. The majority of images were rated as acceptable or excellent in quality (AS: 89-96%; PS: 70-75%). Graders detected AS pathology with 62-81% sensitivity based on photographs, increasing to 87-88% sensitivity with photographs plus CHx. Graders detected PS pathology with 79-86% sensitivity based on a photograph only, increasing to 100% sensitivity with photographs plus CHx. Discussion In this pilot study, there is evidence that portable ophthalmic imaging technologies could enable ophthalmologists to remotely evaluate anterior and posterior segment eye diseases with good sensitivity. The ophthalmologist could detect ocular pathology on photographs more accurately if they were provided brief clinical information.
authors.affiliation: 1 Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.|2 Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Woodward
authors.affiliation: 1 Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: J Clay
authors.initials: JC
authors.lastname: Bavinger
authors.affiliation: 3 Department of Ophthalmology, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Sejal
authors.initials: S
authors.lastname: Amin
authors.affiliation: 1 Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Blachley
authors.affiliation: 1 Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.|4 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.affiliation: 1 Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.|2 Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.affiliation: 1 Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.|2 Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Paula Anne
authors.initials: PA
authors.lastname: Newman-Casey
mesh_terms: D004636:Emergency Service, Hospital; D005123:Eye / Q000473:pathology; D005128:Eye Diseases / Q000175:diagnosis* / Q000473:pathology; D005654:Fundus Oculi; D006801:Humans; D007297:Inpatients; D010781:Photography; D010865:Pilot Projects; D019114:Remote Consultation / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Telemedicine; emergency department; eye; implementation; photography