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Telemedicine screening shown effective for detecting glaucoma
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The telemedicine glaucoma detection process has shown potential in being used both nationally and internationally.
The Philadelphia Telemedicine Glaucoma Detection and Follow-up Study was designed to test the effectiveness of a primary care practice-based screening for eye diseases including glaucoma, using telemedicine.
This study served to consider the potential for telemedicine to improve access for medically underserved, high-risk individuals.
The initial telemedicine screening process included individuals of African American or Hispanic/Latino descent or older than the age of 40 years, Caucasians older than 65 or adults of any ethnicity older than 40 with a family history of diabetes or glaucoma.
Visit 1 involved fundus imaging of 906 eligible individuals. Patients were invited to a second visit due to ocular findings or unreadable fundus images. Both visits were held at the patient’s local primary care practice.
Of those 906 patients, 347 attended a second visit, and 280, or 80.7%, of those were diagnosed with at least one ocular condition, according to the study. These individuals were mostly African American women, with a mean age of 60.6 ± 11.0 years.
For any ocular disease finding, an 86% diagnostic confirmation rate was found between the first and second visit. Of participants with suspicious nerves, 78.1% were diagnosed with glaucoma or glaucoma suspects at visit 2.
These findings support glaucoma screening via telemedicine within high-risk populations and referral to an eye care provider for patients with unreadable fundus images or IOP greater than 21 mm Hg.
Researchers added that education regarding the permanence of glaucoma-related vision loss; emphasizing the importance of follow-up visits; and addressing topics such as cost, poor access, scheduling conflicts as well as lack of insurance are all major factors when treating patients. – by Scott Buzby
Disclosure: Hark reported no relevant financial disclosures. Please see the full study for all other authors’ financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
Glaucoma is undoubtedly a national public health concern. As the second leading cause of irreversible blindness in the U.S., with more than half of these cases undiagnosed, reaching out to community members that may be at greater risk for glaucoma is a priority.
While there are glaring downsides to health care delivery via telemedicine, its potential to reach underserved populations and serve as a screening tool is, in fact, very promising. The Philadelphia Telemedicine Glaucoma Detection and Follow-up Study has demonstrated the ability of telemedicine to screen glaucoma and glaucoma suspects, with their screening protocol identifying these patients with accuracy (as confirmed through comprehensive examination) greater than 78%.
While telemedicine will never replace comprehensive examinations, this study has shown that as a screening modality it can be an effective way to identify patients with glaucoma risk factors. Telemedicine utilization will help prevent vision loss from “the sneak thief of sight” and help promote greater overall awareness of the importance of eye examinations, which will assist in our fight against glaucoma. After all, identifying glaucoma suspects and making an early glaucoma diagnosis are arguably the most significant steps we can take to reducing glaucoma’s risk of blindness.
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