Date of Award

January 2026

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Vicente V. Diaz

Abstract

Background: A hybrid model of teleophthalmology involves an in-person visit for imaging with a technician followed by a telemedicine visit with an ophthalmologist. At our institution, we alternate in-person visits with the hybrid telemedicine visits. Research Aims: This study aims to understand the effectiveness of this alternating hybrid telemedicine model in managing glaucoma-related conditions. Question: The purpose of this study is to evaluate the sensitivity and specificity of this novel telemedicine platform for identifying findings that can lead to management changes for glaucoma. Methods: The medical records of patients seen by a telemedicine-using ophthalmologist at a tertiary eye center for a glaucoma-related condition from September 2023 to October 2024 were reviewed. The main outcome measures were cup-disc ratio, retinal nerve fiber layer thinning, visual field defects, and changes in findings or management between in-person and telemedicine visits. Sensitivity and specificity were calculated, and paired t-tests and chi-squared testing were also employed. Results: A total of 102 patients (mean age 65 years; 63% female) underwent 162 hybrid telemedicine visits for glaucoma-related concerns. The most common diagnoses were glaucoma suspect (36%) and moderate stage glaucoma (26%). Using a χ² test, telemedicine visits demonstrated significantly greater consistency in findings and assessments with in-person visits than would be expected by chance (p < 0.001). The sensitivity of telemedicine in detecting worsening clinical findings was 75%, and the specificity was 100%. Approximately 95% of telemedicine visits had findings and assessments consistent with both preceding and subsequent in-person visits. Statement of scientific impact: This study indicates the effectiveness of a hybrid telemedicine model for monitoring and managing glaucoma progression. Such a model can increase accessibility for patients and reduce wait times.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 07/14/2027

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