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Evaluation of a telemedicine-enabled universal eye health delivery model in rural southern India

Eye volume 38, pages 1202–1207 (2024)Cite this article

Subjects

Abstract

Objectives

To evaluate the accuracy of tele-ophthalmic examination (TOE) for common ocular conditions in comparison with the gold-standard in-person examination (IPE) for diagnosis and treatment advice.

Methods

In a prospective, diagnostic accuracy validation study, we recruited 339 consecutive new patients, aged ≥16 years, visiting a vision centre (VC) associated with Aravind Eye Hospital in south India during January and February, 2020. All participants underwent the TOE, followed by IPE on the same visit. The in-person ophthalmologist was masked to the TOE diagnosis and treatment advice. Data were analysed via the sensitivity specificity of TOE versus the gold-standard IPE.

Results

TOE achieved high sensitivity and specificity for identifying normal eyes with 87.4% and 93.5%, respectively. TOE had high sensitivity for cataracts (91.7%), infective conjunctivitis (72.2%), and moderate sensitivity for pterygium (62.5%), DR (57.1%), non-serious injury (41.7%), but low sensitivity for glaucoma (12.5%). TOE had high specificity ranging from 93.5% to 99.8% for all diagnoses. The sensitivity for treatment advice ranged from 58.1% to 77.2% and specificity from 96.9% to 100%.

Conclusions

The TOE in VCs has acceptable accuracy to an IPE by an ophthalmologist for correctly identifying and treating major eye ailments. Through providing universal eye care to rural populations, this model may contribute to work toward achieving Universal Health Coverage, which is a linchpin of the health-related U.N. Sustainable Development Goals (SDG).

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Data availability

The dataset is available upon request.

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Acknowledgements

The authors acknowledge the cooperation and support from the staff and management of Aravind Eye Hospital, Madurai, India during the study.

Funding

This study was internally funded by the Aravind Eye Care System, India and all the study staff were full-time employees of the organization. JRE was supported by an unrestricted grant from Research to Prevent Blindness to the University of Michigan Department of Ophthalmology and Visual Sciences.

Author information

Authors and Affiliations

  1. Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India

    Sanil Joseph, Vinoth Kumar Rajendran, Dhivya Ramasamy, Amanulla Mohammed Gowth & Thulasiraj D. Ravilla

  2. Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia

    Sanil Joseph

  3. Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia

    Sanil Joseph

  4. Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India

    Dhwanit Khetwani & Akkayasamy Kowsalya

  5. Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, India

    Mohammed Sithiq Uduman

  6. Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, USA

    Joshua R. Ehrlich

  7. Institute for Social Research, University of Michigan, Ann Arbor, USA

    Joshua R. Ehrlich

Authors
  1. Sanil Joseph
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  2. Vinoth Kumar Rajendran
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  5. Dhivya Ramasamy
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  6. Amanulla Mohammed Gowth
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  9. Thulasiraj D. Ravilla
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Contributions

SJ was responsible for designing the study, overseeing the development and implementation of the protocol, creating forms, data collection data analysis and preparation of the manuscript. VK supervised the database development and data collection and contributed to the literature search, development of protocol and manuscript preparation. MSU performed the statistical analyses and contributed to manuscript preparation DK contributed to the protocol development, performed the clinical examinations and oversaw data collection. DR contributed to the conception, design and protocol development. AMG provided logistics and administrative support and contributed to the implementation of the protocol. AK contributed to the protocol development and interpretation of results. JE provided inputs for data analysis and data interpretation and critically revised the manuscript for important intellectual content. TR was involved in the conception, design, data interpretation and overall supervision. All authors gave final approval of the version of the manuscript to be published and agreed to be accountable for all aspects of the work. SJ and TR are guarantors.

Corresponding author

Correspondence to Thulasiraj D. Ravilla.

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Joseph, S., Rajendran, V.K., Khetwani, D. et al. Evaluation of a telemedicine-enabled universal eye health delivery model in rural southern India. Eye 38, 1202–1207 (2024). https://doi.org/10.1038/s41433-023-02871-8

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