Evaluation of the Digital Slit Lamp for Pediatric Anterior Segment Telemedicine Consultations
Tiffany Ho, MD; Bibiana J. Reiser, MS, MD; Carly Stewart, MHA; Thomas C. Lee, MD; Sudha Nallasamy, MD
Children’s Hospital Los Angeles; USC Roski Eye Institute
Los Angeles, CA
Introduction: To evaluate the validity of using videos obtained with the digital slit lamp for assessing anterior segment findings during live-streamed telemedicine consultations.
Methods: Thirty-two children (5-17 years old) with known anterior segment pathology were recruited for this prospective study. A pediatric cornea specialist simultaneously performed and recorded anterior segment examinations using the Topcon Digital-Ready Slit Lamp. Components of the examination included eyelids, eyelashes, conjunctiva, sclera, cornea, iris and lens. Masked to clinical findings, a pediatric ophthalmologist reviewed and graded live video feed transmitted at 4096 kbps. Reliability between remote and gold standard in-person findings was determined by sensitivity, specificity, and kappa statistics.
Results: During examination of 63 eyes (one excluded due to exam intolerance), agreement for conjunctiva/sclera, iris, anterior chamber, and lens findings was almost perfect (sensitivity 89-95%, specificity 95-97%, kappa 0.89-0.95). Substantial agreement was found for cornea pathology (sensitivity 84%, specificity 78%, kappa 0.62). Subtle findings such as mild scars, corneal neovascularization and posterior subcapsular cataracts had higher rates of disagreement.
Discussion: Videos obtained from the Topcon slit lamp have similar sensitivities and specificities as slit lamp photographs obtained with other digital slit lamp devices. Future analyses include re-evaluation of stored video clips by both graders 3 months after conclusion of enrollment to assess intra- and inter-physician reliability.
Conclusion: The digital slit lamp can capture videos of anterior segment examinations with a good level of reliability for use during real-time telemedicine consultations.
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