***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the rate of annual eye examinations  over time among older Americans with diabetes and chronic eye diseases . DESIGN Longitudinal analysis of Medicare cl aims data . PARTICIPANTS R and om sample of Medicare beneficiaries aged 65 years or older . METHODS Beneficiaries were followed between 1991 and 1999 , unless mortality or enrollment in a health maintenance organization for > 6 months in a given 12-month period intervened . All cl aims data ( both physician and facility ) during this time were analyzed for the presence of International Classification of Diseases 9 codes consistent with 1 of the 3 study conditions and the performance of eye examinations . MAIN OUTCOME MEASURES Cl aims su bmi tted by optometrists , ophthalmologists , or other providers of eye care for subjects with diabetes , glaucoma , or age-related macular degeneration ( ARMD ) . Rates were calculated on the basis of a 15-month time window for annual examinations rather than for 12 months to allow for less than full compliance with the guidelines for various reasons ( e.g. , bad weather ) . RESULTS Among those with diabetes in this population , 50 % to 60 % had annual eye examinations  in a 15-month period . Of those followed for at least 75 months after diagnosis , about three quarters had one or more 15-month gaps between visits . For subjects diagnosed with glaucoma , most visit rates were in the 70 % to 90 % range per 15-month period . The percentage of subjects with at least one 15-month period with no visits was considerably lower than for diabetes . The patterns for those with ARMD were in between those for diabetes and glaucoma . Over a nine-year period , only slightly over half of persons with at least one of the study conditions complied with practice guidelines . CONCLUSIONS Annual eye examinations for persons diagnosed with diabetes , glaucoma , and ARMD are important for detecting potentially treatable vision loss among those already diagnosed with these conditions . Currently , actual rates of eye examinations  for persons diagnosed with the study conditions fall far short of recommended rates . As such , approaches to enhancing longitudinal follow-up of those already in the eye care system are needed PURPOSE To evaluate if simple- or multiple-field digital color nonmydriatic ( NM ) retinal images can replace 7 st and ard stereoscopic fundus photographs in the screening of diabetic retinopathy ( DR ) . DESIGN Prospect i ve , masked , comparative case series . METHODS One hundred and eight eyes of 55 diabetics were studied to determine single lesions and to grade clinical levels of DR and diabetic macular edema ( DME ) using both 1 and 3 NM digital color retinal images compared with the Early Treatment Diabetic Retinopathy Study ( ETDRS ) 7 st and ard 35-mm stereoscopic color fundus photographs ( 7F-ETDRS ) . All eyes underwent NM 45-degree field images of 1 central field ( 1F-NM ) , NM 45-degree field images of 3 fields ( 3F-NM ) , and , after pupil dilatation , 30-degree 7F-ETDRS photography . Images were analyzed by 2 independent , masked retinal specialists ( S.V. and E.B. ) , lesion-by-lesion according to the ETDRS protocol and for clinical severity level of DR and DME according to the international classification of DR . RESULTS Using 7F-ETDRS as the gold st and ard , agreement was substantial for grading clinical levels of DR and DME ( kappa = 0.69 and kappa = 0.75 ) vs 3F-NM ; moderate for DR level ( kappa = 0.56 ) and substantial for DME ( kappa = 0.66 ) vs 1F-NM ; almost perfect for detecting presence or absence of DR ( kappa = 0.88 ) vs both 1F-NM and 3F-NM ; and almost perfect for presence or absence of DME ( kappa = 0.97 ) vs 3F-NM and substantial ( kappa = 0.75 ) vs 1F-NM . Sensitivity and specificity for detecting referable levels of DR were 82 % and 92 % , respectively , for 3F-NM and 71 % and 96 % , respectively , for 1F-NM . CONCLUSIONS Three color 45-degree NM fundus fields may be an effective tool in a screening setting to determine critical levels of DR and DME for prompt specialist referral . One central 45-degree image is sufficient to determine absence or presence of DR and DME , but not for grading it BACKGROUND The aims of the study were to determine ( 1 ) whether community optometrists are able to make valid measurements of visual parameters in patients with established or suspect primary open angle glaucoma and ( 2 ) patient satisfaction with follow-up by community optometrists . METHODS A r and omized study was carried out in the former county of Avon in South West Engl and with patients allocated to follow-up by the hospital eye service or by community optometrists .  The subjects were 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria . The main outcome measures were 91 ) measurements of key visual parameters ( intraocular pressure , visual fields and cup/disc ratio ) made by hospital eye service and community optometrists , compared with a research clinic reference st and ard at baseline , and ( 2 ) patient satisfaction at baseline and at six months . RESULTS Community optometrists were able to make measurements of comparable accuracy to those made in the hospital eye service . Patients were significantly more satisfied with a number of aspects of care provided by community optometrists , particularly those relating to waiting times , compared with those from the hospital eye service . CONCLUSIONS Community optometrists are able to make measurements of key visual parameters in patients with established or suspect primary open angle glaucoma which are of comparable quality to the hospital eye service . Follow-up by community optometrists is acceptable to patients . The costs of each option are reported elsewhere AIM To examine the outcome of care for patients with glaucoma followed up by the hospital eye service  compared with those followed up by community optometrists . METHODS A r and omised study with patients allocated to follow up by the hospital eye service or community optometrists  was carried out in the former county of Avon in south west Engl and . 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria were studied . The mean number of missed points on visual field testing in the better eye ( using a “ better/worse ” eye analysis ) in each group were measured . The visual field was measured using the Henson semiautomated central field analyser ( CFA 3000 ) . Measurements were made by the research team on all patients at baseline before r and omisation and again 2 years after r and omisation . The mean number of missed points on visual field testing in the worse eye , mean intraocular pressure ( mm Hg ) , and cup disc ratio using a “ better/worse ” eye analysis in each group at 2 years were also measured . Measurements were made by the research team on all patients at baseline before r and omisation and again 2 years after r and omisation . An analysis of covariance comparing method of follow up taking into account baseline measurements of outcome variables was carried out . Additional control was considered for age , sex , diagnostic group ( glaucoma suspect/established primary open angle glaucoma ) , and treatment ( any/none ) . RESULTS From examination of patient notes , 2780 patients with established or suspected glaucoma were identified . Of these , 752 ( 27.1 % ) fulfilled the entry criteria . For hospital and community follow up group respectively , mean number of missed points on visual field testing at 2 year follow up for better eye was 7.9 points and 6.8 points ; for the worse eye 20.2 points and 18.4 points . Similarly , intraocular pressure was 19.3 mm Hg and 19.3 mm Hg ( better eye ) , and 19.1 mm Hg and 19.0 mm Hg ( worse eye ) ; cup disc ratio at 2 year follow up was 0.72 and 0.72 ( better eye ) , and 0.74 and 0.74 for hospital and community follow up group respectively . No significant differences in any of the key visual variables were found between the two groups before or after adjusting for baseline values and age , sex , treatment , and type of glaucoma . CONCLUSIONS It is feasible to set and run shared care schemes for a proportion of patients with suspected and established glaucoma using community optometrists . After 2 years ( a relatively short time in the life of a patient with glaucoma ) , there were no marked or statistically significant differences in outcome between patients followed up in the hospital eye service or by community optometrists . Decisions to implement such schemes need to be based on careful consideration of the costs of such schemes and local circumstances , including geographical access and the current organisation of glaucoma care within the hospital eye service Abstract Aim To evaluate interobserver agreement for clinical signs in trabeculectomized eyes when examined face-to-face with slit-lamp biomicroscopy ( SL ) or by remote examination using telemedicine ( real-time remote video imaging ; TM ) . Method A system for examining trabeculectomized eyes was devised and vali date d. A prospect i ve r and omized interobserver agreement study was then undertaken to compare st and ard SL biomicroscopy and TM . Remote examination was performed using a 384 kbps Sony 5100 videoconferencing system .  Three ophthalmologists each examined 40 eyes of 40 patients , who had previously undergone trabeculectomy . In rotation , two examiners used SL biomicroscopy . The third examined the eye remotely by TM . Analysis was performed to determine the variability in clinical signs and the presence or absence of systematic bias between ophthalmologists and examination methods . Results High levels of agreement were observed for paired examinations by SL biomicroscopy ( SL/SL ) for bleb vascularity ( score range 0–10 ) with no systematic bias . Paired examination by SL and TM ( SL/TM ) also showed good levels of agreement for bleb vascularity , although the spread of disagreement was wider ( 95 % limits of agreement 2.57 vs 2.98 ( P=0.054 ) ) . For anterior chamber depth , observers agreed within ±10 % of anterior chamber depth for 68 % of eyes ( SL/SL ) and 51 % of eyes ( SL/TM ) ( P=0.68 ) . Agreement was ‘ good ’ for wall thickness ( κ=0.63±0.08 ) , bleb height ( κ=0.67±0.1 ) , and the existence of bleb leak ( κ=0.63±0.19 ) , but poor for bleb morphology ( κ=0.26±0.12 ) . For the SL/TM comparison , agreement was fair for wall thickness ( κ=0.39±0.13 ) , poor for bleb height ( κ=0.17±0.12 ) , good for bleb leak ( κ=0.56±0.19 ) , and fair for bleb morphology ( κ=0.31±0.12 ) . Microcysts were not reliably detected using either technique . Conclusion SL biomicroscopy and TM telemedicine examination may permit reliable clinical assessment of trabeculectomized eyes . However , remote examination with TM is more limited with respect to assessing bleb height and bleb wall thickness . The assessment of bleb morphology and microcysts was unreliable with both instruments . We propose that TM examination of trabeculectomized eyes appears safe and appropriate in situations where face-to-face examination by an ophthalmologist is not practical OBJECTIVE To determine the prevalence of diabetic retinopathy (  DR  )  and evaluate our experience in DR screening in a study carried out between the Ophthalmology Department of the University General Hospital of Alicante and Department 19 Primary Care of Alicante by using a non-retinal mydriatic camera and telemedicine . MATERIAL AND METHODS A descriptive , cross-sectional study was conducted on 2,435 diabetic patients from 1 February 2006 to 1 February 2009 .  Three 45 ° retinographies of both eyes of each patient were obtained and sent to the Department of Ophthalmology via the hospital intranet . These were then evaluated by 2 ophthalmologists , experts in the retina , with each issuing an individualized report for each patient . RESULTS The prevalence of DR was 17.90 % , with 80.73 % of them having mild-moderate proliferative DR , 12.16 % severe non-proliferative DR , 2.29 % proliferative DR , and 4.82 % with diabetic maculopathy associated with any level of retinopathy . The retinographies were considered low quality in 41 patients ( 1.69 % ) . CONCLUSIONS We highlight the benefits of the tele-ophthalmology in screening diabetic patients to enable early diagnosis and treatment , and improving the circuit of communication between primary and specialist care We carried out a prospect i ve study of an Internet-based remote counselling service . A total of 15,456 Internet users visited the Website over eight years . From these , 1500 users were r and omly selected for analysis . Medical counselling had been granted to 901 of the people requesting it ( 60 % ) . One hundred and sixty-four physicians formed project groups to process the requests and responded using email . The distribution of patients using the service was similar to the availability of the Internet : 78 % were from the European Union , North America and Australia . Sixty- 
    Output:
    
The majority of studies indicate  teleophthalmology  as a valid , reliable and cost-efficient method for care-provision in ophthalmology patients which delivers comparable outcomes to the traditional examination methods