Elsevier

American Journal of Ophthalmology

Volume 181, September 2017, Pages 114-124
American Journal of Ophthalmology

Original article
Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods and Screening Results

https://doi.org/10.1016/j.ajo.2017.06.024Get rights and content

Purpose

To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study.

Design

Screening program results for a prospective randomized clinical trial.

Methods

Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist.

Results

From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities.

Conclusion

An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.

Section snippets

Methods

This study describes the screening program results for a prospective randomized clinical trial. The study protocol, consent form, recruitment letters, and all data collection forms were approved by the Wills Eye Hospital Institutional Review Board (IRB) (14-441) and all aspects of the study were conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. This clinical trial is registered with ClinicalTrials.gov (NCT02390245).

Phase 1

Results

Over a 22-month period, from April 1, 2015, to February 6, 2017, 906 participants consented and attended Visit 1. A total of 553 participants (61.0%) were female and 550 (60.7%) African-American, with a mean age of 58.7 years (Table 2). A total of 532 participants (58.7%) had diabetes, with a mean HbA1c of 8.0%. A total of 616 participants (68.0%) had a history of hypertension, with a mean blood pressure of 129.9/78.6 mm Hg (Table 2). During Visit 1, 356 participants (39.3%) screened by

Discussion

This Philadelphia Telemedicine Glaucoma Detection and Follow-up Study provides a clinical screening model in an urban setting to reach those at risk for glaucoma, glaucoma suspect, and other eye diseases. The study aims to develop and evaluate the effectiveness of an innovative and more comprehensive screening method for glaucoma that uses telemedicine imaging in addition to demographic and clinical information (IOP measurements, visual acuity, and family history of glaucoma). Historically,

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    Supplemental Material available at AJO.com.

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