title: Real-time teleophthalmology versus face-to-face consultation: A systematic review.
abstract: Introduction Advances in imaging capabilities and the evolution of real-time teleophthalmology have the potential to provide increased coverage to areas with limited ophthalmology services. However, there is limited research assessing the diagnostic accuracy of face-to-face teleophthalmology consultation. This systematic review aims to determine if real-time teleophthalmology provides comparable accuracy to face-to-face consultation for the diagnosis of common eye health conditions. Methods A search of PubMed, Embase, Medline and Cochrane databases and manual citation review was conducted on 6 February and 7 April 2016. Included studies involved real-time telemedicine in the field of ophthalmology or optometry, and assessed diagnostic accuracy against gold-standard face-to-face consultation. The revised quality assessment of diagnostic accuracy studies (QUADAS-2) tool assessed risk of bias. Results Twelve studies were included, with participants ranging from four to 89 years old. A broad number of conditions were assessed and include corneal and retinal pathologies, strabismus, oculoplastics and post-operative review. Quality assessment identified a high or unclear risk of bias in patient selection (75%) due to an undisclosed recruitment processes. The index test showed high risk of bias in the included studies, due to the varied interpretation and conduct of real-time teleophthalmology methods. Reference standard risk was overall low (75%), as was the risk due to flow and timing (75%). Conclusion In terms of diagnostic accuracy, real-time teleophthalmology was considered superior to face-to-face consultation in one study and comparable in six studies. Store-and-forward image transmission coupled with real-time videoconferencing is a suitable alternative to overcome poor internet transmission speeds.
authors.affiliation: 1 Lions Outback Vision, Lions Eye Institute, Australia.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Tan
authors.affiliation: 1 Lions Outback Vision, Lions Eye Institute, Australia.
authors.forename: Lucy P
authors.initials: LP
authors.lastname: Dobson
authors.affiliation: 1 Lions Outback Vision, Lions Eye Institute, Australia.|2 Sydney School of Public Health, University of Sydney, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bartnik
authors.affiliation: 1 Lions Outback Vision, Lions Eye Institute, Australia.|3 Centre for Ophthalmology and Visual Science, University of Western Australia, Australia.
authors.forename: Josephine
authors.initials: J
authors.lastname: Muir
authors.affiliation: 1 Lions Outback Vision, Lions Eye Institute, Australia.|3 Centre for Ophthalmology and Visual Science, University of Western Australia, Australia.
authors.forename: Angus W
authors.initials: AW
authors.lastname: Turner
mesh_terms: D005128:Eye Diseases / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D020407:Internet; D009885:Ophthalmology / Q000458:organization & administration* / Q000592:standards; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration* / Q000592:standards
keywords: Remote consultation; teleconsulting; telemedicine; teleophthalmology