Evaluation of a Telemedicine Model for Following Keratoconus Patients in the Era of COVID-19 Pandemic

Dana Barequet*, Shay Gutfreund, Michaella Goldstein, Anat Loewenstein, Ronni Gamzu, David Varssano

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate the diagnostic accuracy and reliability of a telemedicine approach for detecting keratoconus patients' progression in the era of coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: A retrospective study, comparing the office and telemedicine evaluations in determining whether keratoconus patients were at risk of progression and indicated for further treatment of corneal crosslinking, was conducted. The clinic examination included best spectacle corrected visual acuity measurement and manifest refraction, full ophthalmic examination, and corneal topography, which provided with the gold-standard diagnosis. The remote assessment included two decisions of keratoconus progression or stability: The first evaluation after revealing patient demographics and topography images, and the second with the manifest refraction and clinical findings as documented in the outpatient clinic visit. Results: Two-hundred and four eyes of 102 keratoconus patients were included. There was an agreement of assessment between the in-person and the remote diagnostic decisions in 192 (94%) of the eyes. Among the remaining 12 eyes, a false-positive diagnosis was made in 8 (3.9%) eyes, whereas a false-negative diagnosis was made in 4 (1.9%) eyes. The remote assessment showed a sensitivity and specificity of 69% and 96%, respectively. In no case was remote diagnostic decision 2 different from remote decision 1. Conclusions: The telemedicine model yielded high specificity, but low sensitivity values, therefore, not suitable as an alternative for keratoconus patient follow-up (Clinical trial number TLV-0363-20).

Original languageEnglish
Pages (from-to)1023-1027
Number of pages5
JournalTelemedicine Journal and e-Health
Issue number7
StatePublished - 1 Jul 2022


  • COVID-19
  • keratoconus
  • telemedicine
  • teleophthalmology


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