Evaluation of digital slit-lamp videos for paediatric anterior segment telemedicine consultations. (July 2023)

• Record Type: Journal Article
• Authors: Mulchandani, Divya; Reiser, Bibiana J; Ho, Tiffany C; Reid, Mark W; Stewart, Carly; Lee, Thomas C; Nallasamy, Sudha
• Is Part Of: Journal of telemedicine and telecare. Volume 29:Number 6(2023)
• Page Start: 467
• Page End: 473
• Publication Date: 2023-07
• Subjects: Digital slit lamp -- anterior segment -- paediatric -- telemedicine -- teleophthalmology, diagnostic accuracy; Telecommunication in medicine -- Periodicals; 610
• DOI: 10.1177/1357633X21990991
• Languages: English
• ISSNs: 1357-633X

Abstract

Introduction: This study aimed to assess the validity of telemedicine consultations using digital slit-lamp videos to detect anterior segment pathology in a paediatric population. Methods: A paediatric anterior segment specialist simultaneously performed and recorded anterior segment examinations using the Topcon digital-ready slit lamp. Components of the examination included the eyelids/eyelashes, conjunctiva/sclera, cornea, anterior chamber, iris and lens. Masked to clinical findings, a paediatric ophthalmologist reviewed and graded the live video feed transmitted at 4 Mbps. At least three months later, both ophthalmologists graded the stored videos. We compared the sensitivity, specificity, percent agreement and weighted kappa (κ) of diagnosing anterior segment pathologies via live-streamed and store-and-forward video clips compared to the in-person standard examination. Results: Examinations of 89 eyes from 45 children (5–17 years old) with known anterior segment pathology were included. Agreement between live-streamed and in-person standard examinations for conjunctiva/sclera, anterior chamber, iris and lens findings was almost perfect (sensitivity 89–96%, specificity 95–100%, κ = 0.87–0.97). Substantial agreement was found for cornea pathology (sensitivity 88%, specificity 90%, κ = 0.72), and moderate agreement was found for eyelids/eyelashes pathology (sensitivity 54%, specificity 92%, κ = 0.46). Store-and-forward results were similar, though slightly better for eyelids/eyelashes and slightly worse for conjunctiva/sclera. Discussion: Digital slit-lamp videos hold promise for synchronous and asynchronous telemedicine in diagnosing paediatric anterior segment pathologies.