Telemedicine diagnosis of aids-related retinopathies by direct ophthalmoscopy

Purpose. Direct ophthalmoscopes with real time video-linked capabilities are present in each of the 59 sites within the Georgia Statewide Telemedicine System (GSTS). We performed a pilot study to determine the sensitivity and specificity of the GSTS direct ophthalmoscope in ne diagnosis of AIDS-related retinopathies. Methods Thirty three eyes of seventeen AIDS patients with CD4 counts <50 cells/ml were recruited. Subjects underwent dilated, direct ophthalmoscopic fundus examination by a non-ophthalmologist physician with telemedical transmission of real time images to an ophthalmologist. A gold standard, in-person comprehensive examination, including indirect ophthalmoscopy, was performed by a second ophthalmologist. Telemedical evaluation was compared to the in-person comprehensive examination. Results. Twenty one eyes did not demonstrate retinal disease by in-person examination. Of the 21 disease-free eyes,telemedical examination correctly evaluated 20 eyes as disease free (specificity = 95%). HIV retinopathy was present in 12 of 33 eyes as determined by in-person examination. Ten of the 12 eyes with HIV retinopathy were correctly diagnosed by telemedical evaluation(sensitivity = 83%). Conclusions. Direct ophthalmoscopic telemedical evaluation may possess the potential to assist the primary care physician in evaluating patients for AIDS-related retinopathies.