Diagnostic accuracy of a remote eye exam in measuring refractive errors and detecting cataract, glaucoma, and diabetic retinopathy

Porpuse: Approximately 2.2 billion people worldwide have some type of visual impairment and among these, many could have been avoided or solved if adequate care had been provided in a timely manner. In these cases, telemedicine can assist in solving the problems of many ophthalmological conditions by providing support, performing screening, telediagnosis or supervision of distant appointments. The use of telemedicine for eye health is well established for some eye diseases, such as diabetic retinopathy, macular diseases and strabismus, however, there is a lack of information on diagnostic accuracy for other ophthalmological pathologies prevalent in the world population, such as refractive errors. To evaluate the reliability of the diagnosis made through teleophthalmology, using the ophthalmologist's face-to-face diagnosis as the gold standard. Methods: A diagnostic accuracy study was carried out, with 216 patients assessed by the TeleOftalmo project who underwent eye examinations both on-site and through telemedicine. The patients underwent refraction tests, intraocular pressure measurement, photodocumentation in the slit-lamp and subjective refraction using the visual acuity screen and the digital refractor. Results: The conditions evaluated were refractive errors, cataracts, diabetic retinopathy and suspected glaucoma. Kappa values, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Approximately, 61.6% of the sample were women, with mean age of 47 years old. Kappa values show strong reliability regarding the diagnosis of cataracts (k = 0.86) and diabetic retinopathy (k = 0.79). Regarding refractive errors and suspected glaucoma, the kappa values were considered moderate (k = 0.598 and 0.478, respectively). Conclusion: The use of telemedicine has shown favorable results regarding the diagnosis of refractive errors, cataracts and diabetic retinopathy, as well as moderate reliability for suspected glaucoma. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Financial support was provided by the Brazilian Ministry of Health, through its Programa de Apoio ao Desenvolvimento Institucional do SUS (PROADI-SUS), and by the Rio Grande do Sul State Health Department. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the Institutional Review Board of Hospital de Clínicas de Porto Alegre, in Porto Alegre – Rio Grande do Sul, Brazil. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript