Related Experiment Video
Updated: Nov 12, 2025
Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
Published on: March 24, 2020
Reliability of telemedicine for real-time paediatric ophthalmology consultations
Carly Stewart1, Josephine Coffey-Sandoval1, Mark W Reid1
1The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.
Insights
Real-time telemedicine accurately diagnoses and manages pediatric eye conditions, showing high agreement with in-person exams. This technology can improve access to care for children needing specialized ophthalmology services.
Area of Science:
- Ophthalmology
- Telemedicine
- Digital Health
Background:
- Assessing the diagnostic and management accuracy of real-time telemedicine for pediatric eye conditions.
- Evaluating the reliability of virtual consultations in pediatric ophthalmology.
Purpose of the Study:
- To determine the accuracy of telemedicine in diagnosing and managing pediatric eye conditions.
- To compare telemedicine diagnoses and management plans with in-person examinations.
Main Methods:
- Prospective, non-inferiority study design.
- Paediatric optometrist conducted live telemedicine exams streamed to an ophthalmologist.
- Comparison of diagnoses and management plans between telemedicine and same-day in-person re-examinations.
Main Results:
- High agreement (ICC=0.98-1.00, Kappa=0.94-1.00) in angle measurements and disease categorization for strabismus.
- No changes in primary diagnoses or management plans after in-person review.
- High patient and family satisfaction with telemedicine quality (98.5%) and willingness to participate again (97.1%).
Conclusions:
- Real-time telemedicine is a reliable method for diagnosing and managing pediatric ophthalmic conditions.
- Telemedicine can enhance access to care for underserved populations through collaboration between optometrists and ophthalmologists.
Background/Aims:
To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions.
Methods:
Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0-17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was <1.5% for management plan or <15% for diagnosis discrepancies.
Results:
210 patients participated in 348 examinations. 131 (62.4%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98-1.00) and disease categorisation (kappa=0.94-1.00) (p<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5%) and would participate in another in the future (97.1%).
Conclusion:
Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology.
