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) |
|---|---|
| Journal | American Journal of Ophthalmology |
| Volume | 152 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 2011 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Ophthalmology
Cite this
Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis. / Ausayakhun, Somsanguan; Skalet, Alison; 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.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Accuracy and reliability of telemedicine for diagnosis of cytomegalovirus retinitis
AU - Ausayakhun, Somsanguan
AU - Skalet, Alison
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
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
SN - 0002-9394
IS - 6
ER -