TY - JOUR
T1 - Diagnostic Accuracy of Technology-based Eye Care Services
T2 - The Technology-based Eye Care Services Compare Trial Part I
AU - Maa, April Y.
AU - Medert, Charles M.
AU - Lu, Xiaoqin
AU - Janjua, Rabeea
AU - Howell, Ashley V.
AU - Hunt, Kelly J.
AU - McCord, Sarah
AU - Giangiacomo, Annette
AU - Lynch, Mary G.
N1 - Funding Information:
This project would not have been possible without the support of the Atlanta VA Ophthalmology Chief, Dr. Steven Urken, the Atlanta VA Eye Clinic staff, the reading physicians, the medical students, and the ophthalmic technicians. A special thanks to the project's Research Coordinator, Deirdre Dixon, whose hard work and commitment to the project were truly invaluable to the study's success. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Partially funded by an Atlanta Clinical and Translational Institute Translational Research grant. The funding source had no role in the design or conduct of this study. Obtained funding: Maa, Lynch
Publisher Copyright:
© 2019
PY - 2020/1
Y1 - 2020/1
N2 - Purpose: Ophthalmologic telemedicine has the ability to provide eye care for patients remotely, and many countries have used screening tele-ophthalmology programs for several years. One such initiative at the Veterans Affairs (VA) Healthcare System is Technology-based Eye Care Services (TECS). The TECS services are located in primary care clinics and provide basic screening eye care, including vision, refraction, and retinal photography. Eye care providers (“readers”) review the clinical data and recommend appropriate follow-up. One of the most common referrals from TECS has been for glaucoma, and this study was powered for glaucoma/glaucoma suspect detection. The current study was undertaken to identify aspects of the protocol that could be refined to enhance accuracy. Design: Prospective comparison between the standard TECS protocol versus a face-to-face (FTF) examination on 256 patients, all of whom had no known history of significant ocular disease. Participants: Patients with no known ocular disease who were scheduled for an in-person eye appointment at the Atlanta VA. Patients underwent screening through the TECS protocol and received an FTF examination on the same day (gold standard). The TECS readers were masked to the results of the FTF examination. Main Outcome Measures: Percent agreement, kappa, sensitivity, and specificity were calculated for the TECS readers’ interpretations versus the FTF examination. Results: The TECS readers showed substantial agreement for cataract (κ ≥ 0.71) and diabetic retinopathy (κ ≥ 0.61) and moderate to substantial agreement for glaucoma/glaucoma suspect (κ ≥ 0.52) compared with an FTF examination. Age-related macular degeneration (AMD) showed moderate agreement (κ ≥ 0.34). Percent agreement with the TECS protocol was high (84.3%–98.4%) for each of the disease categories. Overall sensitivity and specificity were ≥75% and ≥55%, respectively, for any diagnosis resulting in referral. Inter-reader and intra-reader agreement was substantial for most diagnoses (κ > 0.61) with percent agreements ranging from 66% to 99%. Conclusions: Our results indicate that the standard TECS protocol is accurate when compared with an FTF examination for the detection of common eye diseases. The inclusion of additional testing such as OCT could further enhance diagnostic capability.
AB - Purpose: Ophthalmologic telemedicine has the ability to provide eye care for patients remotely, and many countries have used screening tele-ophthalmology programs for several years. One such initiative at the Veterans Affairs (VA) Healthcare System is Technology-based Eye Care Services (TECS). The TECS services are located in primary care clinics and provide basic screening eye care, including vision, refraction, and retinal photography. Eye care providers (“readers”) review the clinical data and recommend appropriate follow-up. One of the most common referrals from TECS has been for glaucoma, and this study was powered for glaucoma/glaucoma suspect detection. The current study was undertaken to identify aspects of the protocol that could be refined to enhance accuracy. Design: Prospective comparison between the standard TECS protocol versus a face-to-face (FTF) examination on 256 patients, all of whom had no known history of significant ocular disease. Participants: Patients with no known ocular disease who were scheduled for an in-person eye appointment at the Atlanta VA. Patients underwent screening through the TECS protocol and received an FTF examination on the same day (gold standard). The TECS readers were masked to the results of the FTF examination. Main Outcome Measures: Percent agreement, kappa, sensitivity, and specificity were calculated for the TECS readers’ interpretations versus the FTF examination. Results: The TECS readers showed substantial agreement for cataract (κ ≥ 0.71) and diabetic retinopathy (κ ≥ 0.61) and moderate to substantial agreement for glaucoma/glaucoma suspect (κ ≥ 0.52) compared with an FTF examination. Age-related macular degeneration (AMD) showed moderate agreement (κ ≥ 0.34). Percent agreement with the TECS protocol was high (84.3%–98.4%) for each of the disease categories. Overall sensitivity and specificity were ≥75% and ≥55%, respectively, for any diagnosis resulting in referral. Inter-reader and intra-reader agreement was substantial for most diagnoses (κ > 0.61) with percent agreements ranging from 66% to 99%. Conclusions: Our results indicate that the standard TECS protocol is accurate when compared with an FTF examination for the detection of common eye diseases. The inclusion of additional testing such as OCT could further enhance diagnostic capability.
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U2 - 10.1016/j.ophtha.2019.07.026
DO - 10.1016/j.ophtha.2019.07.026
M3 - Article
C2 - 31522900
AN - SCOPUS:85072087231
SN - 0161-6420
VL - 127
SP - 38
EP - 44
JO - Ophthalmology
JF - Ophthalmology
IS - 1
ER -