Electronic Thesis and Dissertation Repository

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Dr. Monali Malvankar-Mehta

Abstract

Teleglaucoma is a screening device that remotely detects glaucoma cases at earlier stages using electronically-transferred stereoscopic digital imaging. Thus, patient wait and travel times are reduced, as well as, patient load in ophthalmic clinics. The purpose is to synthesize literature to evaluate teleglaucoma: its diagnostic accuracy, the healthcare system benefits, and its cost-effectiveness. A systematic review was conducted with published and unpublished studies. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. Using Markov Modelling, a cost-effectiveness analysis was conducted. Of 11237 studies reviewed, 45 were included. Teleglaucoma was more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The ICER calculated for teleglaucoma was $27,460/QALY. In conclusion, teleglaucoma was found to be more cost-effective than in-person examination in rural areas.


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