Review: This prospective, non-inferiority study assessed the discrepancy in diagnosis and management plan between real-time telemedicine and in-person examination in the context of paediatric eyecare. A paediatric optometrist used digital equipment to livestream a paediatric ophthalmologist and subsequently the ophthalmologist completed an in-person re-examination on the same day. The equipment included a high-definition camera built into glasses, a digital slit-lamp and a digital indirect ophthalmoscope connected to livestream video.
There were 348 examinations conducted for 210 patients. No primary diagnoses or management plans were changed following the in-person exam. Two non-primary diagnoses were noted in-person only but did not affect management plans. There was excellent agreement of angle measurements for strabismus patients and a very high satisfaction rate, with 98.5% of families comfortable with the telemedicine exam quality and 97.1% willing to participate again. Equipment challenges with short delays were encountered in 11.5% of the exams.
Comment: There is hope for reliable and accessible telemedicine to reduce paediatric disease burden in underserved populations. Asynchronous telemedicine in the context of retinopathy of prematurity is already well-validated. This study demonstrates general paediatric ophthalmic conditions could be reliably managed with real-time telemedicine.
The authors acknowledge the significant learning curve for both the optometrist and ophthalmologist, as well as possible confirmation bias within this study. Equipment cost may also be a barrier to scaling this model of care. Technology advances and the fast pace of digital streaming and artificial intelligence evolution will inevitably improve, increasing access to telemedicine in future practice.
G-ROP criteria for predicting retinopathy of prematurity among neonates with different birth weight percentiles
