As glaucoma continues to impact more people each year, it is becoming increasingly important to improve early detection and screening. Telemedicine may be useful in achieving this goal because hand-held cameras can capture fundus and optic disc images at convenient locations, notes one of the authors of the following study, Lisa Hark, PhD. “Emerging ophthalmic imaging technologies will likely revolutionize future practice-based and community-based eye screening models,” she said in a Practice Update commentary. However, these images do not come without limitations.1

Upon attempting to ascertain determinants of unreadable fundus images, researchers came to the conclusion that understanding the causes will improve telemedicine’s accuracy, efficiency and cost.2

Patients included in the study were screened for glaucoma at seven primary care practices and four federally qualified health centers using telemedicine. Screening included obtaining fundus photographs, learning family glaucoma history and performing intraocular pressure measurements. Participants with an unreadable image in at least one eye were deemed unreadable and asked to return for a confirmatory eye exam. Of the total participants, 906 completed the eye screening, 155 (17%) of who were unreadable.

The team found that older age, male gender, smoking and worse visual acuity were significantly associated with an unreadable fundus image. Of the 89 participants who returned for the confirmatory eye exam, the researchers note that 58 (65%) were diagnosed with at least one ocular pathology. They add that the most frequent diagnoses were cataract (n=71; 15 visually significant, 56 non-visually significant), glaucoma suspect (n=27) and anatomical narrow angle (n=10).

“These screening results indicate that individuals with an unreadable fundus image would benefit from a comprehensive eye exam,” Dr. Hark says. She adds that patients must first understand the importance of returning for this exam.

1. Analysis of unreadable fundus images obtained in a telemedicine screening program for glaucoma detection. Practice Update. October 18, 2018. Accessed January 24, 2019.

2. Hark L, Murdakhayev E, Press L, et al. Analysis of unreadable fundus images obtained in a telemedicine screening program for glaucoma detection. J Glaucoma. 2018;7(11):999–1008.