Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Analysis of Unreadable Fundus Images

Lisa A. Hark*, Jonathan S. Myers, Kamran Rahmatnejad, Qianqian Wang, Tingting Zhan, Sarah E. Hegarty, Benjamin E. Leiby, Sanika Udyaver, Michael Waisbourd, Stela Leite, Jeffrey D. Henderer, Louis R. Pasquale, Paul P. Lee, Julia A. Haller, L. Jay Katz

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Purpose: The purpose of this study was to ascertain determinants of unreadable fundus images for participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. Methods: Individuals were screened for glaucoma at 7 primary care practices and 4 Federally Qualified Health Centers using telemedicine. Screening (visit 1) included fundus photography, assessing family history of glaucoma, and intraocular pressure (IOP) measurements. Participants with an unreadable image in at least one eye were deemed unreadable and invited to return for a confirmatory eye examination (visit 2). Results: A total of 906 participants completed the visit 1 eye screening and 17.1% (n=155/906) were "unreadable." In the multivariable logistic regression analysis, older age, male sex, smoking, and worse visual acuity were significantly associated with an unreadable fundus image finding at the eye screening (P<0.05). Of the 89 participants who were invited for the confirmatory eye examination solely for unreadable images and attended visit 2, 58 (65.2%) were diagnosed with at least one ocular pathology. The most frequent diagnoses were cataracts (n=71; 15 visually significant, 56 nonvisually significant), glaucoma suspects (n=27), and anatomical narrow angle (n=10). Conclusions: Understanding the causes of unreadable fundus images will foster improvements in telemedicine techniques to optimize the predictive accuracy, efficiency, and cost in ophthalmology. A high proportion of participants with unreadable images (65.2%) in our study were diagnosed with some ocular pathology, indicating that the finding of an unreadable fundus image warrants a referral for a comprehensive follow-up eye examination.

Original languageEnglish
Pages (from-to)999-1008
Number of pages10
JournalJournal of Glaucoma
Volume27
Issue number11
DOIs
StatePublished - 1 Nov 2018
Externally publishedYes

Funding

FundersFunder number
National Institutes of HealthU01DP005127
National Institutes of Health

    Keywords

    • fundus
    • fundus
    • glaucoma
    • glaucoma
    • photography
    • photography
    • telemedicine
    • telemedicine
    • unreadable image
    • unreadable image

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