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. 2011 Dec;152(6):1053-1058.e1.
doi: 10.1016/j.ajo.2011.05.030. Epub 2011 Sep 8.

Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis

Somsanguan Ausayakhun  1 , Alison H Skalet, Choeng Jirawison, Sakarin Ausayakhun, Jeremy D Keenan, Claire Khouri, Khang Nguyen, Partho S Kalyani, David Heiden, Gary N Holland, Todd P Margolis
Affiliations

Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis

Somsanguan Ausayakhun et al. Am J Ophthalmol. 2011 Dec.

Abstract

Purpose: To determine the feasibility of remote diagnostic screening for cytomegalovirus (CMV) retinitis among HIV patients in northern Thailand.

Design: Prospective, observational cross-sectional study.

Methods: One hundred eighty-two eyes from 94 consecutive patients with HIV seen in 2008 and 2009 at a tertiary university-based medical center were photographed using a digital retinal camera. Individual and composite images were uploaded to a secure web site. Three expert graders accessed the electronic images and graded each image for signs of CMV retinitis. Results of remote expert grading were compared with on-site patient examination by local expert ophthalmologists.

Results: On-site ophthalmologists diagnosed CMV retinitis in 89 (48.9%) of 182 eyes. Trained ophthalmic photographers obtained digital retinal images for all 182 eyes. As compared with the on-site examinations, the sensitivity for detecting CMV retinitis by remote readers using composite retinal images ranged from 89% to 91%. The specificity for detecting CMV retinitis by remote readers ranged from 85% to 88%. Intrarater reliability was high, with each grader achieving a κ value of 0.93. Interrater reliability among the 3 graders also was high, with a κ value of 0.86.

Conclusions: Remote diagnostic screening for CMV retinitis among HIV-positive patients may prove to be a valuable tool in countries where the burden of HIV exceeds the capacity of the local eye care providers to screen for ocular opportunistic infections.

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Figures

Figure 1.
Figure 1.
Representative fundus images of CMV retinitis from a tertiary medical center in northern Thailand, captured with the Topcon TRC-NW 6S digital fundus camera. Images captured disease in zone 1 (upper left, upper right, lower left) and zone 2 (upper right, lower left, lower right).
Figure 1.
Figure 1.
Representative fundus images of CMV retinitis from a tertiary medical center in northern Thailand, captured with the Topcon TRC-NW 6S digital fundus camera. Images captured disease in zone 1 (upper left, upper right, lower left) and zone 2 (upper right, lower left, lower right).
Figure 1.
Figure 1.
Representative fundus images of CMV retinitis from a tertiary medical center in northern Thailand, captured with the Topcon TRC-NW 6S digital fundus camera. Images captured disease in zone 1 (upper left, upper right, lower left) and zone 2 (upper right, lower left, lower right).
Figure 1.
Figure 1.
Representative fundus images of CMV retinitis from a tertiary medical center in northern Thailand, captured with the Topcon TRC-NW 6S digital fundus camera. Images captured disease in zone 1 (upper left, upper right, lower left) and zone 2 (upper right, lower left, lower right).
See this image and copyright information in PMC

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