Accuracy and Reliability of Telemedicine for Diagnosis of Cytomegalovirus Retinitis

作者：Ausayakhun Somsanguan; Skalet Alison H; Jirawison Choeng; Ausayakhun Sakarin; Keenan Jeremy D; Khouri Claire; Khang Nguyen; Kalyani Partho S; Heiden David; Holland Gary N; Margolis Todd P^*

来源：American Journal of Ophthalmology, 2011, 152(6): 1053-1058.

DOI：10.1016/j.ajo.2011.05.030

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 kappa value of 0.93. Interrater reliability among the 3 graders also was high, with a kappa 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. (Am J Ophthalmol 2011;152:1053-1058.

• 出版日期2011-12