Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis

Somsanguan Ausayakhun; 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

doi:10.1016/j.ajo.2011.05.030

Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis

Somsanguan Ausayakhun, 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

Ophthalmology

Research output: Contribution to journal › Article

22 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1053-1058.e1
Journal	American journal of ophthalmology
Volume	152
Issue number	6
DOIs	https://doi.org/10.1016/j.ajo.2011.05.030
State	Published - Dec 2011

ASJC Scopus subject areas

Ophthalmology

Access to Document

10.1016/j.ajo.2011.05.030

Fingerprint Dive into the research topics of 'Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis'. Together they form a unique fingerprint.

Cite this

Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis. / Ausayakhun, Somsanguan; Skalet, Alison H.; Jirawison, Choeng; Ausayakhun, Sakarin; Keenan, Jeremy D.; Khouri, Claire; Nguyen, Khang; Kalyani, Partho S.; Heiden, David; Holland, Gary N.; Margolis, Todd P.

In: American journal of ophthalmology, Vol. 152, No. 6, 12.2011, p. 1053-1058.e1.

Research output: Contribution to journal › Article

Ausayakhun, Somsanguan ; Skalet, Alison H. ; Jirawison, Choeng ; Ausayakhun, Sakarin ; Keenan, Jeremy D. ; Khouri, Claire ; Nguyen, Khang ; Kalyani, Partho S. ; Heiden, David ; Holland, Gary N. ; Margolis, Todd P. / Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis. In: American journal of ophthalmology. 2011 ; Vol. 152, No. 6. pp. 1053-1058.e1.

@article{19d2c738293e4b6996acb87315c8cb75,

title = "Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis",

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.",

author = "Somsanguan Ausayakhun and Skalet, {Alison H.} and Choeng Jirawison and Sakarin Ausayakhun and Keenan, {Jeremy D.} and Claire Khouri and Khang Nguyen and Kalyani, {Partho S.} and David Heiden and Holland, {Gary N.} and Margolis, {Todd P.}",

year = "2011",

month = dec,

doi = "10.1016/j.ajo.2011.05.030",

language = "English (US)",

volume = "152",

pages = "1053--1058.e1",

journal = "American Journal of Ophthalmology",

issn = "0002-9394",

publisher = "Elsevier USA",

number = "6",

}

TY - JOUR

T1 - Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis

AU - Ausayakhun, Somsanguan

AU - Skalet, Alison H.

AU - Jirawison, Choeng

AU - Ausayakhun, Sakarin

AU - Keenan, Jeremy D.

AU - Khouri, Claire

AU - Nguyen, Khang

AU - Kalyani, Partho S.

AU - Heiden, David

AU - Holland, Gary N.

AU - Margolis, Todd P.

PY - 2011/12

Y1 - 2011/12

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=81855167035&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81855167035&partnerID=8YFLogxK

U2 - 10.1016/j.ajo.2011.05.030

DO - 10.1016/j.ajo.2011.05.030

M3 - Article

C2 - 21861977

AN - SCOPUS:81855167035

VL - 152

SP - 1053-1058.e1

JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

SN - 0002-9394

IS - 6

ER -