The Muranga Teleophthalmology Study: Comparison of Virtual (Teleglaucoma) with in-Person Clinical Assessment to Diagnose Glaucoma

Citation:
Kiage D, Irfan N, Gichuhi S, Karim D, Nyenze E. "The Muranga Teleophthalmology Study: Comparison of Virtual (Teleglaucoma) with in-Person Clinical Assessment to Diagnose Glaucoma." Middle East Journal of Ophthalmology. 2013;20(2):150-7.

Abstract:

Purpose: While the effectiveness of teleophthalmology is generally accepted, its ability to
diagnose glaucomatous eye disease remains relatively unknown. This study aimed to compare
a web-based teleophthalmology assessment with clinical slit lamp examination to screen for
glaucoma among diabetics in a rural African district.

Materials and Methods: Three hundred and nine diabetic patients underwent both the clinical
slit lamp examination by a comprehensive ophthalmologist and teleglaucoma (TG) assessment
by a glaucoma subspecialist. Both assessments were compared for any focal glaucoma damage;
for TG, the quality of photographs was assessed, and vertical cup-to-disk ratio (VCDR) was
calculated in a semi-automated manner. In patients with VCDR > 0.7, the diagnostic precision
of the Frequency Doubling Technology (FDT) C-20 screening program was assessed.
Results: Of 309 TG assessment photos, 74 (24%) were deemed unreadable due to media
opacities, patient cooperation, and unsatisfactory photographic technique. While the
identification of individual optic nerve factors showed either fair or moderate agreement, the
ability to diagnose glaucoma based on the overall assessment showed moderate agreement
(Kappa [κ] statistic 0.55% and 95% confidence interval [CI]: 0.48-0.62). The use of FDT to
detect glaucoma in the presence of disc damage (VCDR > 0.7) showed substantial agreement
(κ statistic of 0.84 and 95% CI 0.79-0.90). A positive TG diagnosis of glaucoma carried a 77.5%
positive predictive value, and a negative TG diagnosis carried an 82.2% negative predicative
value relative to the clinical slit lamp examination.

Conclusion: There was moderate agreement between the ability to diagnose glaucoma using
TG relative to clinical slit lamp examination. Poor quality photographs can severely limit the
ability of TG assessment to diagnose optic nerve damage and glaucoma. Although further
work and validation is needed, the TG approach provides a novel, and promising method to
diagnose glaucoma, a major cause of ocular morbidity throughout the world.

Key words: Glaucoma, Optic Neuropathy, Slit Lamp Examination, Teleglaucoma,
Teleophthalmology

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