Validation of portable slit lamp videos and anterior segment photographs as telemedicine modalities

ABSTRACT

Purpose: The COVID-19 pandemic has highlighted the need for telemedicine across all specialties. Though its utilization has increased since the start of the pandemic, ophthalmology has been reported to be among the specialties least likely to utilize telemedicine in practice. We evaluated the potential utility of portable slit lamp exam (SLE) videos and anterior segment photos as telemedicine modalities by comparing the findings from these modalities to those identified in-person in the clinic. Methods: Data was collected from 98 subjects at Rutgers Institute of Ophthalmology and Visual Science by non-ophthalmic trained staff, which included portable SLE videos and anterior segment photos, collected with Microclear digital hand-held slit lamp (Suzhou, China) and Canon non-mydriatic retinal camera CR-2 Plus AF (Tokyo, Japan), respectively. Analysis included anterior segment photos taken from 92 patients (183 eyes) and SLE videos taken from 91 patients (177 eyes), which were interpreted and compared to exam findings identified in-person in the clinic. Sample t-tests were used for statistical analysis. Results: Nuclear sclerotic cataract (NSC) had the most agreement between telemedicine interpretation and in-person exam (photo 93.8%, video 93.75%). Cortical cataract showed less agreement (photo 65.63%, video 45.16%) and posterior subcapsular cataract (PSC) showed the least agreement (photo 8.33%, video 0%) among cataract findings. Cornea findings were among those least likely to be identified (photo 12.5%, video 14.86%). Findings that showed statistically significant differences between photo and video included pinguecula (p=0.00032). PSC (p=0.044) and posterior capsule opacification (p=0.00098) showed statistically significant differences regarding identifying findings on telemedicine interpretation that were not documented in clinic. Conclusions: Portable SLE videos and anterior segment photos may have potential for utility as means of telemedicine, particularly for NSC. Portable SLE requires more training to display a full ophthalmic exam whereas photographs can easily be done by non-ophthalmic trained staff, displaying similar findings. Differences in exam findings may be attributed to lack of documentation when patients present to the clinic for more urgent concerns and lack of focus on slit lamp videos by non-ophthalmic trained staff. (Figure Presented).