While telemedicine is proving to be a key technology for screening programs around the world, some are giving it a try for basic eye care, including the Department of Veterans Affairs. The health system recently implemented technology-based eye care services (TECS) in several primary care clinics to help provide basic eye care such as vision, refraction and retinal photography.

A study published in Ophthalmology took a close look at the protocol’s efficacy, particularly for one of the most common referrals from TECS: glaucoma. The researchers found the TECS screening protocol is accurate compared with face-to-face exams for the detection of many common eye diseases, but may be further enhanced with additional testing, such as OCT.

The prospective studied examined 256 patients, all of who had no known history of significant ocular disease. Participants underwent screening through the TECS protocol and received an in-person exam on the same day. Eye care providers, or “readers”, reviewed the TECS clinical data and made recommendations accordingly, with no knowledge of the clinical outcomes of the in-person exam.

The team discovered that the TECS readers showed substantial agreement for diagnosing cataract and diabetic retinopathy, moderate to substantial agreement for glaucoma and glaucoma suspects and moderate agreement for age-related macular degeneration compared with the in-person exams.

They note that the agreement between the two approaches was high (84.3% to 98.4%) for each of the disease categories and that overall sensitivity and specificity were ≥75% and ≥55%, respectively, for any diagnosis resulting in a referral. They add that inter- and intra-reader agreement was substantial for most diagnoses, with agreements ranging from 66% to 99%.

Maa AY, Medert CM, Lu X, et al. Diagnostic accuracy of technology-based eye care services (TECS): the TECS compare trial part I. Ophthalmology. August 13, 2019. [Epub ahead of print].