A study out of the Duke University Medical Center has demonstrated that remote diagnosis imaging and a standard examination carried out by a retinal specialist appeared equivalent in identifying referable macular degeneration in patients within a setting with relatively high disease prevalence. Researchers believe this can potentially contribute to delivering timely treatment.
The team tested the feasibility and accuracy of the device as a clinical screening tool by having 159 patients undergo remote imaging, which was defined as color fundus photography (CFP) and optical coherence tomography (OCT) of non-dilated pupils and performed by non-expert imagers at primary care clinics in areas with high disease prevalence. CFP is the current standard for teleophthalmic screening and monitoring of retinal disease. Retinal specialists also performed the traditional dilated eye examination on the patients.
The standard examination determined that 35 eyes (22%) required referral to a retinal specialist. For the remote diagnosis images, 241 (96.4%) of the OCT images were deemed to be interpretable, but only 164 (65.6%) of the CFP were interpretable. Remote diagnosis had high diagnostic accuracy in identifying referable macular degeneration. Both OCT and CFP had 94% sensitivity, while OCT had specificity higher than CFP (93% vs. 63%). However, researchers believe combining to the two technologies could improve clinical and cost-effectiveness of macular degeneration screening.
Using Cohen’s kappa statistic, the study found substantial agreement between the standard examination and OCT (κ = 0.83) and also between it and CFP (κ = 0.76). According to a patient satisfaction survey, 76.7% of participants preferred remote imaging over the standard care evaluation.
Researchers believe that remote diagnosis could offer a convenient, efficient, low-cost, sustainable and high quality care delivery model of diagnosing retinal diseases.
|Hadziahmetovic M, Nicholas P, Jindal S, et al. Evaluation of a remote diagnosis imaging model vs. dilated eye examination in referable macular degeneration. JAMA Ophthalmol. May 16, 2019. [Epub ahead of print].|