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

Research output: Contribution to journal › Article › peer-review

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
Externally published	Yes

ASJC Scopus subject areas

Ophthalmology

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10.1016/j.ajo.2011.05.030

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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 › peer-review

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.

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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.}",

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AU - Holland, Gary N.

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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.

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Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis

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