Non-ophthalmologists diagnose CMV retinitis with reasonable accuracy

1. For non-experts, sensitivity in diagnosing CMV retinitis ranged from 64.0% to 95.5% and specificity ranged from 65.6% to 92.5%.

2. When compared to the expert consensus as a standard, mean sensitivity and specificity for non-experts were 93.2% and 88.4% respectively.

Evidence Rating Level: 2 (Good)

Study Rundown: Cytomegalovirus (CMV) retinitis is a serious complication of advanced HIV disease that results in blindness. Although its prevalence in developed countries is low, it remains a major cause of blindness in developing nations due to the lack of screening in HIV patients. In order to improve the identification of this disease entity, this study attempted to assess the accuracy of its diagnosis by non-ophthalmologists (non-experts). The sensitivity and specificity of non-experts in detecting CMV retinitis ranged from 64.0% to 95.5% and 65.6% to 92.5% respectively. However, when compared to the expert consensus, mean sensitivity and specificity for non-experts were 93.2% and 88.4% respectively. Strengths of the study include the use of both American and Thai non-experts with stratified levels of expertise. Limitations include the fact that some patients had been previously diagnosed with CMV retinitis and were currently being treated. Nonetheless, these data indicate that telemedicine with non-experts could be an effective screening tool for CMV retinitis if individuals are provided the appropriate training.

Click to read the study in JAMA Ophthalmology

Relevant Reading: Accuracy and Reliability of Remote Retinopathy of Prematurity Diagnosis

In-Depth: In this study, patients seen at a clinic in Thailand had funduscopic photos taken, which were sent to a remote location and read by non-ophthalmologists who had previously received basic training in eye anatomy and the recognition of CMV retinitis. Ophthalmologists on-site also evaluated the patients with a complete funduscopic eye exam. Each grader decided whether the patient had CMV retinitis or not, and the results were compiled for all graders and compared to the expert consensus. There was greater variability in the range of accuracy of the non-experts, while minimal variability with ophthalmologists (88.8% to 91.0% sensitivity and 84.9% to 88.2% specificity). Overall the study demonstrates that non-experts could be potentially trained to diagnosed CMV retinitis in developing countries in order to curtail the spread of irreversible blindness.

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Image: PD

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