Examination of ocular adnexa and anterior segment via telemedicine

Purpose. To investigate the accuracy of telemedicine slit lamp evaluation in comparison with in-person evaluation in examining ocular adnexa and the anterior segment. Methods. 50 eyes of 25 patients from a mixed general and glaucoma ophthalmology clinic underwent slit lamp biomicroscopy of ocular adnexa and anterior segment by an ophthalmologist. The in-person (gold standard) examination of 21 possible findings were compared to the results obtained via telemedicine for these patients. Sensitivity and specificity and their 95% confidence intervals were calculated for each finding. Results. (% sensitivity/specificity). Blepharitis: 80/0; lid mass: 100/64; conj pigment: 100/85; pingueculum: 70/93 ; cornea scar: 56/98; iridotomy: 83/93; post synechiae: 100/100; lens: cortical: 100/91; nuclear: 57/93; IOL: 37/100; chamber depth: 67/13. Conclusions. Contrasts of both color and morphologic depth cues have the highest sensitivity and specificity. Accuracy is poor for findings lacking these features. Current monocular slit lamp hookups are limiting. Technology to allow stereo transmission would likely improve sensitivity and specificity.