@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.}",
note = "Funding Information: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Publication of this article was supported by the University of California, San Francisco-Gladstone Institute of Virology and Immunology Center for AIDS Research, University of California at San Francisco Research Evaluation and Allocation Committee, San Francisco, California; That Man May See; the Littlefield Trust; The Peierls Foundation; and a number of grateful patients. This project also was supported by the National Center for Research Resources/Office of the Director Grant KL2 RR024130 , which funds the University of California, San Francisco Clinical and Translational Science Institute, and; by Grant K23EY019071 from the National Eye Institute, National Institutes of Health , Bethesda, Maryland (J.D.K.); and by the Skirball Foundation, New York, New York (G.N.H.). Involved in Study design (So.A., J.D.K., Sa.A., C.K., A.H.S., D.H., G.N.H., T.P.M.); Conduct of study (So.A., J.D.K., Sa.A., C.J., C.K., D.H., G.N.H., T.P.M.); Collection of data (So.A., J.D.K., Sa.A., C.J., C.K., T.P.M.); Management of data (So.A., J.D.K., Sa.A., C.K., K.N.); Analysis of data (J.D.K.); interpretation of data (So.A., J.D.K., A.H.S., D.H., G.N.H., T.P.M.); Preparation of manuscript (A.H.S., So.A.), Review of manuscript (So.A., J.D.K., Sa.A., C.J., C.K., A.H.S., P.S.K., D.H., G.N.H., T.P.M.); and Approval of manuscript (So.A., J.D.K., Sa.A., C.J., C.K., A.H.S., K.N., P.S.K., D.H., G.N.H., T.P.M.). So.A and A.H.S. contributed equally to this article. Institutional review board approval was obtained at the University of California, San Francisco, and Chiang Mai University, Chiang Mai, Thailand. The study adhered to the tenets of the Declaration of Helsinki. All study participants gave written informed consent. ",
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",
}