Telemedicine monitoring for AMD patients

Introduction. - AMD follow-up is a public health issue in developed countries due to aging of the population and medical demographics. Telemedicine may be a means of improving follow-up. Purpose. - To compare the agreement between telemedicine and in-person consultations in terms of indications for intravitreal injections in exudative AMD patients. Materials and methods. - From January 2017 to April 2017, AMD patients followed on a PRN protocol at a single center, Rennes university medical center, were included. The telemedicine evaluation was read by two anonymous experts on the basis of the medical record including visual acuity and fundus photographs. The agreement between conventional follow-up and telemedicine in terms of indications for intravitreal injections, as well as interobserver agreement, were tested with the Cohen's kappa coefficient using SAS statistical software V9.4 (SAS Institute, Cary, NC). Results. - In total, 104 eyes corresponding to 57 consultations for 42 patients were analyzed. The mean age was 82.12 years (standard deviation +/- 6.4). Recommendations for anti-VEGF were similar between the standard and telemedicine visits in 97 % of cases. The Kappa coefficient was 0.8861 [0.76; 1.00], P< 0.0001 for agreement between telemedicine and in-person consultation. The Kappa coefficient was 0.8441 [0.70; 0.99], P< 0.0001 for interobserver agreement. We observed 5 cases of disagreement between the two observers. Discussion. - The concordance was very good in our study. The few cases of disagreement resulted mainly from poorly interpretable examinations due to poor image quality, major macular changes in patients with a prior examination, and the fact that only a single cut was analyzed. Conclusion. - AMD monitoring by telemedicine seems promising and reliable. This approach would allow better follow-up of patients with difficult access to care. (C) 2020 Elsevier Masson SAS. All rights reserved.