Diagnostic performance of a telemedicine system for ophthalmology: advantages in accuracy and speed compared to standard care

Abstract

Telemedicine has potential to improve quality and delivery of medical care, particularly in image-oriented specialties where decisions are based on appearance of morphological features during examination. In the ophthalmology domain, nearly all published telemedicine studies have measured accuracy against a gold standard of ophthalmoscopic examination. The purposes of this study are to examine difficulties in defining an absolute gold standard and to compare diagnostic speed in a representative disease, retinopathy of prematurity. We compare results from ophthalmoscopic and telemedicine examinations by the same physicians. In 180 (86.5%) of 208 eyes, the two examinations produced the same diagnosis. In some discrepancies, there was rationale suggesting that telemedicine may have provided a more accurate diagnosis than ophthalmoscopic examination. The quantity and nature of these disagreements has important implications for evaluation of telemedicine systems in image-based specialties, and for the definition of gold standards in future studies.

Figure 1.

Example of image-based telemedicine diagnosis interface. Multiple images from both eyes are displayed, and basic demographic information is shown.

Figure 2.

Examples of disagreements. In (A), ROP was documented by image-based exam (arrow point at vertical white line denoting peripheral disease) but not by ophthalmoscopy. In (B), there was disagreement regarding whether dilation and tortuosity of vessels was sufficient to meet criteria for severe ROP.