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Patients with unreadable fundus image at higher risk of ocular pathology
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A majority of patients called in for confirmatory eye exams due to unreadable fundus images taken during their initial exams were found to have glaucoma, according to a study published in Journal of Glaucoma.
In telemedicine, readable fundus images are crucial to glaucoma detection. Hark and colleagues found that 17.1% of study participants had unreadable images of one or both eyes.
Reasons for unreadable images included suboptimal patient cooperation, such as movement of the eye or head; operator and instrument problems, such as poor focus and instrument failure; and ocular causes that included small pupils, cataracts and corneal scars.
“Understanding the causes of unreadable fundus images will foster improvements in telemedicine techniques to optimize the predictive accuracy, efficiency and cost in ophthalmology,” Hark and colleagues wrote.
The 906 participants were gathered from geographically diverse and underserved neighborhoods throughout Philadelphia. Participants underwent glaucoma screening at seven primary care practices and four federally qualied health centers.
Visit 1 screening included fundus photography, assessing family history of glaucoma and IOP measurements.
Of the participants with an unreadable image (n = 155) of at least one eye, 89 were invited to return for visit 2, a conrmatory eye examination.
According to the researchers, 58 of the visit 2 participants were then diagnosed with at least one ocular pathology. These diagnoses included cataracts, glaucoma and anatomically narrow angle.
“Although likely visually asymptomatic, mild cataracts or mild posterior capsular opacification in pseudophakic eyes can still render retinal image quality suboptimal,” the authors wrote. “Other factors such as pupil size, ocular surface and technician/patient variation likely explain for unreadable images when lens clarity is not an issue.”
Researchers concluded that due to the high number of participants diagnosed with some form of ocular pathology, the finding of an unreadable fundus image warrants a follow-up, comprehensive eye exam. Additionally, researchers expressed the need for doctors to communicate the possibility of an unreadable image to patients on a telemedicine consent form, informing participants about the importance of returning for a complete eye examination. – by Scott Buzby
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Glaucoma affects 2 million Americans and is responsible for 9% to 12% of the total cases of blindness. We know that the earlier this disease is detected and treated, the better the outcome. Stunningly, an estimated 50% of glaucoma remains undiagnosed. To combat glaucoma-induced vision loss, you don’t need a new $100K, super-HD, next-gen imaging device, you need patients sitting in your chair. Well, you might need that new instrument too…
Telemedicine to the rescue! Optometrists screen for hypertension and refer accordingly. Telemedicine allows these medical practitioners to return the favor by collecting inexpensive fundus photos and having them screened for disease. These screening programs can accurately identify glaucoma and other retinal pathologies (namely diabetic retinopathy) if the images are readable. However, non-mydriatic fundus photos are difficult to acquire, and about 17% of them are unreadable. Hark and colleagues found that of patients with unreadable fundus images, 65% demonstrated ocular pathology when subsequently examined by an eye care professional.
Telemedicine was first envisioned as a way to bring modern care to remote, underserved communities. Today it seems that it may find its primary use as a screening tool. In the glaucoma arena, this will enable earlier diagnosis and treatment, which will surely reduce the impact of this disease, helping those who are most in need.
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