Small-angle strabismus detection by telemedicine in an experimental model.

Area of Science:

• Ophthalmology
• Telemedicine
• Strabismus Detection

Background:

• Strabismus, or eye misalignment, diagnosis traditionally relies on in-person examinations.
• Telemedicine offers a potential alternative for remote ophthalmic assessments.
• Alternate cover testing is a key diagnostic maneuver for strabismus.

Purpose of the Study:

• To evaluate the accuracy of detecting strabismus using telemedicine via alternate cover testing.
• To assess how video conditions impact the accuracy of strabismus detection remotely.

Main Methods:

• Videos with induced strabismus (up to 12 prism diopters) were recorded using alternate cover testing.
• Recordings varied head posture, lighting, fixation target, and viewing angle.
• Observers with different expertise levels assessed video accuracy.

Main Results:

• Detection accuracy decreased with smaller strabismus angles (12Δ: 94%, 8Δ: 72%, 4Δ: <50%).
• Esotropia and hypertropia were detected more accurately than exotropia.
• Backlighting and fixation target motion negatively impacted accuracy; observer expertise did not.

Conclusions:

• Telemedicine and alternate cover testing can accurately detect strabismus, even small angles.
• Optimizing video quality, particularly fixation targets and lighting, is crucial for accurate remote strabismus assessment.