Accuracy and Reliability of Telemedicine for Diagnosis of Cytomegalovirus Retinitis

被引：20

作者：

Ausayakhun, Somsanguan ^{[2
]}

Skalet, Alison H. ^{[1
,3
]}

Jirawison, Choeng ^{[2
]}

Ausayakhun, Sakarin ^{[2
]}

Keenan, Jeremy D. ^{[1
,3
]}

Khouri, Claire ^{[1
,3
]}

Khang Nguyen ^{[1
,3
]}

Kalyani, Partho S. ^{[4
]}

Heiden, David ^{[5
,6
]}

Holland, Gary N. ^{[4
]}

Margolis, Todd P. ^{[1
,3
]}

机构：

[1] Univ Calif San Francisco, FI Proctor Fdn, San Francisco, CA 94143 USA

[2] Chiang Mai Univ, Dept Ophthalmol, Fac Med, Chiang Mai 50000, Thailand

[3] Univ Calif San Francisco, Dept Ophthalmol, San Francisco, CA 94143 USA

[4] Univ Calif Los Angeles, Dept Ophthalmol, Los Angeles, CA USA

[5] Calif Pacific Med Ctr, Dept Ophthalmol, San Francisco, CA USA

[6] Calif Pacific Med Ctr, Pacific Vis Fdn, San Francisco, CA USA

来源：

AMERICAN JOURNAL OF OPHTHALMOLOGY | 2011年 / 152卷 / 06期

基金：

美国国家卫生研究院;

关键词：

ACTIVE ANTIRETROVIRAL THERAPY; DIABETIC-RETINOPATHY; IMAGE-ANALYSIS; AIDS; PREMATURITY; DISEASE; SYSTEM; ERA;

D O I：

10.1016/j.ajo.2011.05.030

中图分类号：

R77 [眼科学];

学科分类号：

100212 ;

摘要：

PURPOSE: To determine the feasibility of remote diagnostic screening for cytomegalovirus (CMV) retinitis among HIV patients in northern Thailand. DESIGN: Prospective, observational cross-sectional study. METHODS: One hundred eighty-two eyes from 94 consecutive patients with HIV seen in 2008 and 2009 at a tertiary university-based medical center were photographed using a digital retinal camera. Individual and composite images were uploaded to a secure web site. Three expert graders accessed the electronic images and graded each image for signs of CMV retinitis. Results of remote expert grading were compared with on-site patient examination by local expert ophthalmologists. RESULTS: On-site ophthalmologists diagnosed CMV retinitis in 89 (48.9%) of 182 eyes. Trained ophthalmic photographers obtained digital retinal images for all 182 eyes. As compared with the on-site examinations, the sensitivity for detecting CMV retinitis by remote readers using composite retinal images ranged from 89% to 91%. The specificity for detecting CMV retinitis by remote readers ranged from 85% to 88%. Intrarater reliability was high, with each grader achieving a kappa value of 0.93. Interrater reliability among the 3 graders also was high, with a kappa value of 0.86. CONCLUSIONS: Remote diagnostic screening for CMV retinitis among HIV-positive patients may prove to be a valuable tool in countries where the burden of HIV exceeds the capacity of the local eye care providers to screen for ocular opportunistic infections. (Am J Ophthalmol 2011;152:1053-1058. (C) 2011 by Elsevier Inc. All rights reserved.)

引用

页码：1053 / 1058

页数：6

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