Background/aims To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions. Methods Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0–17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was <1.5% for management plan or <15% for diagnosis discrepancies. Results 210 patients participated in 348 examinations. 131 (62.4%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98–1.00) and disease categorisation (kappa=0.94–1.00) (p<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5%) and would participate in another in the future (97.1%). Conclusion Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology. Data are available on reasonable request. De-identified participant data may be available on reasonable request. Please contact the Principal Investigator, Dr. Sudha Nallasamy (sudha.nallasamy@gmail.com).

中文翻译：

---

远程医疗在实时儿科眼科会诊中的可靠性

背景/目的 评估实时远程医疗诊断和管理儿科眼疾的准确性。方法 设计：前瞻性、非劣效性研究分析远程医疗和亲自检查之间的诊断和管理计划的一致性。地点：小儿眼科诊所。人群：0-17 岁的儿童，讲英语或讲西班牙语，能够以适合年龄的方式参与，以前由验光师看过并需要眼科转诊或新近从外部转诊。程序：儿科验光师使用数字设备进行检查，并将现场直播给记录诊断和管理计划的儿科眼科医生，然后亲自重新检查患者。受试者被掩盖了他们将在同一天亲自见到眼科医生的事实。主要结果测量：远程医疗和亲自检查之间的管理计划或诊断差异。管理计划的非劣效性阈值 <1.5% 或诊断差异的非劣效性阈值 <15%。结果 210例患者参加了348项检查。131 (62.4%) 人将斜视作为主要诊断。在这些患者中，观察到角度测量（组内相关系数=0.98-1.00）和疾病分类（kappa=0.94-1.00）（在所有情况下p<0.0001）的一致性非常好。亲自检查后没有改变主要诊断，也没有改变管理计划。54/55 的患者在初次就诊时同意接受手术，但他们蒙面接受亲自检查。家庭对远程医疗检查的质量感到满意 (98. 5%）并将在未来参与另一个（97.1%）。结论 通过远程医疗可以可靠地诊断和管理小儿眼科疾病。眼科医生和验光师之间的合作可以使用这项技术来改善服务不足的人群。可根据合理要求提供数据。可根据合理要求提供去识别的参与者数据。请联系首席研究员 Sudha Nallasamy 博士 (sudha.nallasamy@gmail.com)。可根据合理要求提供去识别的参与者数据。请联系首席研究员 Sudha Nallasamy 博士 (sudha.nallasamy@gmail.com)。可根据合理要求提供去识别的参与者数据。请联系首席研究员 Sudha Nallasamy 博士 (sudha.nallasamy@gmail.com)。