1. Purpose Results Results Methods Conclusion
Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Screening Results and Eye Exam Diagnosis Agreement
Kamran Rahmatnejad, MD; Lisa A. Hark, PhD, RD; Michael Waisbourd, MD; Jonathan S. Myers, MD; Anand V. Mantravadi, MD;
Shae Reber; Scott J. Fudemberg, MD; Jeffrey D. Henderer, MD; Julia A. Haller, MD; Tingting Zhan, PhD and L. Jay Katz, MD 
Wills Eye Hospital Glaucoma Research Center and Telemedicine Department, and Temple University Hospital, Philadelphia, PA
Purpose
Results
Results
To determine the agreement between a community-based, telemedicine screening diagnosis and confirmation eye exam results in the Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study.
Following the telemedicine-screening (Visit 1), 40.9% (n=351/859) had a normal screening result, 36.2% (n=311/859) were diagnosed with an abnormal image or suspicious discs, 6.4% (55/859) had OHTN with normal discs, and 16.5% (n=142/859) had unreadable images.
A total of 305 subjects completed both the screening Visit 1 and confirmation eye exam at Visit 2 (Table1).
Of the 311 subjects with abnormal results at Visit 1:
32.8% were glaucoma-suspect (n=102)
7.7% had diabetic retinopathy (n= 24)
7.7% had other retinal pathology (n= 24)
Of the 198 individuals who were diagnosed with suspicious discs at the screening Visit 1 and attended the confirmation eye exam at Visit 2, 142/198 (71.7%) were confirmed as glaucoma or glaucoma suspect.
Of the 56 subjects who were diagnosed with diabetic retinopathy at the screening Visit 1 and attended the confirmation Visit 2, 36/56 (64.2%) were confirmed as having diabetic retinopathy.
Methods
Subjects (African American, Hispanic, or Asian individuals age >40; Caucasian age >65; and those age >40 with diabetes or a family history of glaucoma) were offered eye screenings (Visit 1) in primary care practices (PCP) and Federally Qualified Health Centers (FQHC).
Visit 1 consisted of an ocular, medical, and family history; fundus photographs using a non-mydriatic, auto-focus, hand-held fundus camera (Volk, Ohio, USA); IOP measurements (iCare, Helsinki, Finland); and visual acuity (Snellen).
Subjects with abnormal images, ocular hypertension (OHTN) (IOP >21 mm Hg), and unreadable images were invited for an eye exam in the same community location (Visit 2).
Table 1: Demographic and Clinical Characteristics of Philadelphia Telemedicine Glaucoma Detection Study Subjects (N=305)
Variable
Data
Age (y), mean (SD)
58.2 (10.3)
Gender, Male (%)
43.9
African American (%)
74.1 
Caucasian (%)
18.0
Family history of glaucoma (%)
24.3
Glaucoma suspect (%)
45.0
Primary open angle glaucoma (%)
9.5
Normal tension glaucoma (%)
0.3
Ocular hypertension (%)
0.2
Diabetic retinopathy (%)
11.8
Other retinal pathology (%)
8.5
Conclusion
This project clearly demonstrates how a community-based telemedicine screening program can improve access, detection, and follow-up eye care of individuals at high-risk for glaucoma and other eye diseases.
The community-based, telemedicine eye screening effectively detected new cases of glaucoma, glaucoma suspect, diabetic retinopathy, and other retinal pathology.
Visit 2 (PCP/FQHC)
Complete eye exam
n=305
Visit 1 (PCP/FQHC) Fundus photos / IOP n=859
Funded by the Centers for Disease Control and Prevention
Cooperative Agreement: U01 DP005127
Contact: Kamran Rahmatnejad, MD;