Key Messages
What Is the Issue?
- Teleoptometry can offer vision and eye health services to people living in areas where there is a shortage of optometrists and ophthalmologists. However, there is a need to evaluate the potential benefits and potential harms of teleoptometry to ensure that all people receive high-quality eye care, regardless of their place of residence.
- The relative accuracy and utility of teleoptometry compared to in-person eye exams is unclear. The need for this review was identified by a policy decision-maker, and this review is a response to that request.
What Did We Do?
- To inform decisions on the use of teleoptometry for comprehensive eye exams and for screening, diagnosing, and monitoring eye disease, we conducted a Rapid Review to summarize evidence that compared the clinical effectiveness, diagnostic test accuracy, and clinical utility of teleoptometry to in-person eye exams. We also sought to identify evidence-based guidelines regarding the use of teleoptometry.
- We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2020.
- The purpose of this report is to summarize and critically appraise the available evidence on the topic, but it does not provide formal recommendations about teleoptometry. The report was externally reviewed by a clinical expert.
What Did We Find?
- We identified several limitations with relevant studies that impact the interpretation of their findings and the generalizability of the evidence. Teleoptometry exams varied greatly in how they were delivered (e.g., asynchronous, synchronous), the types and number of eye tests included, and who performed the in-person components. Some studies included only a small number of eye tests for the teleoptometry and the in-person exam, which may not reflect current clinical practice. In general, the study participants were relatively young, and most studies did not account for disease severity, limiting conclusions for older adults and different stages of disease.
- For adults with no known vision or eye conditions, teleoptometry may be similar to in-person eye exams in detecting and managing reduced vision due to uncorrected refractive error. However, teleoptometry may miss some ocular health abnormalities. Eye care providers may feel less confident, and patients less satisfied, with teleoptometry. These findings are based on the results from 1 cross-sectional study.
- When used for screening eye diseases and conditions, teleoptometry showed high specificity in most studies (9 test accuracy studies). This means it is generally good at correctly classifying people who do not have certain eye diseases or conditions.
- The sensitivity of teleoptometry to detect eye diseases and conditions varied within and across the 9 included studies. Teleoptometry showed good to high sensitivity for some conditions (i.e., cataracts; clinically significant macular edema; nystagmus; and abnormalities of the cornea, anterior chamber, iris, or lens), correctly identifying about 85% to 93% of people with these indications. However, sensitivity was very low to moderate for other conditions (e.g., diabetic retinopathy, glaucoma, age-related macular degeneration), meaning these conditions may be missed in teleoptometry exams.
- Teleoptometry may offer a similar ability to inform patient management plans as an in-person exam in pediatric patients with some ocular features or pathologies. These findings are based on the results from 1 cross-sectional study. We did not find any evidence about the clinical utility of teleoptometry for the screening, diagnosing, or monitoring of eye diseases in adults.
- For people with diabetic retinopathy, 1 guideline recommends that teleoptometry programs may use retinal imaging (stereoscopic or non-stereoscopic), reimage or refer individuals with poor-quality images, and use relevant clinical history to support image interpretation and reporting.
- For people with primary open-angle glaucoma, 1 guideline recommends that teleoptometry can improve access to care but that teleoptometry should not be used alone or for the assessment or management of moderate or advanced disease.
- We did not find any studies that compared teleoptometry to in-person comprehensive eye exams in children, and we did not find any guidelines about the use of teleoptometry for routine comprehensive eye exams in adults or children.
What Does This Mean?
- Teleoptometry may be a suitable alternative to an in-person eye exam in some adults for assessing reduced vision due to uncorrected refractive error and identifying some ocular conditions. However, the evidence was limited to 1 study with a small number of participants, and it is unclear whether teleoptometry would be a suitable replacement for a comprehensive eye exam.
- The accuracy of teleoptometry for screening and diagnosing eye diseases varies by condition and may depend on the diagnostic tests performed and the training of the individual collecting the data. Teleoptometry is generally good at identifying people without eye diseases but may miss some conditions in people who do have them. Several study limitations lower our confidence in these results, suggesting that teleoptometry may not fully replace in-person eye care in all clinical situations.
- To inform their decisions about the use of teleoptometry, decision-makers can consider the limitations of the technology, whether it is appropriate for the clinical scenario, the type and design of the teleoptometry exam, and the individual needs and preferences of the individuals being examined.
- Decision-makers may also wish to consider whether the provision of teleoptometry would impact access to eye care, particularly in areas or populations that may otherwise be underserved by eye care professionals. In such areas, teleoptometry may serve to increase access to eye care or augment in-person eye care.