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Evaluation of a telemedicine model for exudative age-related macular degeneration follow-up

Session Details

Session Title: AMD II

Session Date/Time: Friday 27/09/2013 | 08:00-10:00

Paper Time: 09:52

Venue: Hall 3 (Level 0)

First Author: J.Andonegui SPAIN

Co Author(s):    D. Aliseda   A. Eg?zkiza   L. Serrano   J. Maya     

Abstract Details

Purpose:

To evaluate a telemedicine model for exudative age related macular degeneration (AMD) follow up and to compare the time spent with this model with the time spent in office examination

Setting:

The introduction of anti-VEGF in the treatment of AMD has provided an impressive benefit in terms of visual acuity but at the same time follow-up of patients with this disease has become burdensome for retina specialists and new approaches are needed to face it.

Methods:

We compared the results of office examination and telemedicine evaluation at the time of deciding if patients with exudative AMD treated with at least three anti-VEGF injections needed additional intravitreal treatment. Office examination included visual acuity, fundus exam and optical coherence tomography (OCT). Telemedicine evaluation included assessment of digital retinographies and OCTs as well as the data of visual acuity obtained in office examination. Retinographies and OCTs were converted to DICOM (Digital Imaging and Communication in Medicine) files and stored in a PACS (Picture Archiving and Communication System) server. They were downloaded from the PACS server for telemedicine evaluation by means of a DICOM visualizer. Indications to repeat treatment were persistent macular fluid detected by OCT, visual acuity loss in conjunction with macular fluid detected by OCT and new macular hemorrhage. We also measured the time spent in telemedicine evaluation and compared it with office examination.

Results:

185 patients were included in the study. 79 were male (43%) and 106 female (57%). Mean age was 81 years. During office examination in 76 cases (41%) the decision was to repeat the intravitreal injection while in 109 cases (59%) it was decided not to repeat treatment. With respect to the comparison among office and telemedicine evaluation, in 166 cases the results were the same. Among the 19 remaining patients and considering office examination as the gold standard, 16 correspond to false positives (office examination indicates not to repeat treatment but telemedicine examination indicates to repeat treatment) and 3 to false negatives (office examination indicates to repeat treatment but telemedicine examination indicates not to repeat treatment). With these data the sensitivity and specificity of telemedicine evaluation are 96 and 87% respectively. The average amount of time spent in telemedicine evaluation is 1 minute 21 seconds compared with 10 minutes spent in office examination (p<0,00001).

Conclusions:

The telemedicine model described in this study can be a useful alternative for AMD follow-up. It is less time consuming for retina specialists than office examination and provides a more rational approach for digital image management.

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