[Comparison between in-person physical examination and telemedicine with portable equipment in elderly fall-risk...

To assess diagnostic and clinical decision concordance between a face-to-face ophthalmological examination using handheld equipment and an asynchronous teleophthalmology assessment in disabled elderly fall-risk patients as well as the feasibility of this approach.

This prospective single-center study evaluated a diagnostic method. Disabled elderly fall-risk patients underwent an in-person ophthalmological examination using a handheld slit-lamp followed by an asynchronous teleophthalmology assessment based on videos acquired by handheld anterior segment and fundus cameras. Diagnostic and management concordance were assessed using Cohen's kappa coefficient. Feasibility was evaluated by the rate of readable examinations.

A total of 142 patients (281 eyes) were included. Concordance was very good for phakic/pseudophakic status assessment (kappa=0.87-0.96), moderate for lens assessment (kappa=0.51-0.58) and macular evaluation (kappa=0.48-0.57), and low for other anterior (cornea, iris) and posterior segment (optic nerve head, retinal vessels) assessment as well as for overall clinical decision-making (kappa=0.15-0.35). Feasibility was excellent for anterior segment examination (90-98%) and acceptable for posterior segment assessment (61-81%). A clinical decision could be proposed via teleophthalmology in 50-72% of cases. The main causes of visual impairment were cataract, age-related macular degeneration, and optic neuropathy.

Asynchronous teleophthalmology using handheld equipment appears feasible in disabled elderly patients, with variable reliability depending on the parameters assessed. Technological, organizational, and methodological improvements are required before broader implementation.