Ultra-Widefield Imaging as a Teleophthalmology Screening Tool for Ocular Pathology

Tessnim R Ahmad,1 Winnie A Situ,2 Nicholas T Chan,2 Jeremy D Keenan,1,3 Jay M Stewart1,2 1Department of Ophthalmology, University of California, San Francisco, CA, USA; 2Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; 3Francis I. Proctor Foundation, University of California, San Francisco, CA, USACorrespondence: Jay M Stewart, University of California, Department of Ophthalmology, 490 Illinois Street, Floor 5, San Francisco, CA, 94143-4081, USA, Tel +1 (628) 206-3123, Email Jay.Stewart@ucsf.eduBackground: Prior studies have validated ultra-widefield imaging as a remote screening tool for diabetic retinopathy. The aim of this study was to determine its use in screening for any fundus pathology in a routine patient population.Methods: In this prospective randomized study, patients underwent both slit lamp indirect ophthalmoscopy and ultra-widefield imaging. Ultra-widefield images were independently reviewed by two optometrists, and discrepancies were adjudicated by a retina specialist. Clinical findings from slit-lamp examiners and image-reviewers were coded into themes and clinically meaningful findings were extracted. Cohen’s kappa was used to estimate agreement for these findings between the two image-reviewers and between the image-reviewers and slit-lamp examiners.Results: Nine-hundred eyes of 450 patients were examined and imaged, of which 616 eyes were analyzed. At least one abnormal fundus finding was present on ophthalmoscopy in 71 eyes (11%) and on adjudicated image interpretation in 166 eyes (27%). Agreement between the two image-reviewers was moderate to substantial for most clinically meaningful findings, including optic disc hemorrhage (κ = 0.8), macular exudates (κ = 0.7), and macular pigmentary changes (κ = 0.7). Agreement between examiners and image-reviewers was moderate to substantial for optic disc hemorrhage (κ = 1), indistinct optic disc margins (κ = 0.5), drusen (κ = 0.4), pigmentary changes (κ = 0.4), and hemorrhage (κ = 0.8). A total of 187 findings were detected by imaging but not examination, compared with 42 that were detected on examination but not imaging.Conclusion: In a routine patient population, ultra-widefield imaging agreed with standard-of-care slit-lamp examinations and detected more fundus findings.Keywords: ultra-widefield imaging, teleophthalmology, screening, telehealt