Evaluation of Sensitivity and Specificity of Acuity 360 Telemedicine Vision Screening System.

Purpose: Our aim is to evaluate the sensitivity and specificity of Acuity 360 telemedicine system, as compared to in-person clinic examination, in identifying clinically significant eye disease. Acuity 360 is a combination of commercially available ocular imaging devices used together to provide a comprehensive evaluation of the structures and diseases of the eye. Methods: Observational cross-sectional study of consecutively examined patients where 19 remote examiners analyzed 80 patients using Acuity 360 images. The examiners' diagnoses were compared to the diagnosis obtained from in-person clinic examination of all the patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false-negative rate, and inter-rater agreement were calculated. Results: Compared to in-person clinic examination, the sensitivity, specificity, PPV, NPV, and false-negative rate for the optical coherence tomography (OCT) of optic nerve were 95.8%, 98.5%, 86.8%, 99.6%, 0.39% and for the combined retina examination (OCT of the macula and widefield fundus photography) were 93.4%, 88.5%, 80.2%, 96.4%, 2.19%, respectively. The median inter-rater agreement the OCT of optic nerve and the combined retina examination were each 95%. Conclusion: The Acuity 360 telemedicine system has a low false-negative rate and is highly sensitive and specific when compared to an in-person clinic examination. It can determine the necessity for specialist referral and triage the patients that require urgent treatment. High inter-rater agreement shows that it is effective with minimal variability in analyzing the Acuity 360 images by remote examiners.