Teleophthalmology in Diabetic Retinopathy

Over the past decade, there have been rapid strides in progress in the fields of telecommunication and medical imaging. There is growing evidence regarding use of teleophthalmology for screening of diabetic retinopathy. This article highlights some pertinent questions regarding use of telescreening for diabetic retinopathy. It deals with evidence regarding accuracy of diagnosis, patients satisfaction and cost-effectiveness. The American Telemedicine Association have given certain guidelines for teleheath practices for diabetic retinopathy. The article discusses regarding these guidelines. Finally, a working model for diabetic retinopathy screening through teleophthalmology has been described. Telescreening for diabetic retinopathy seems to be a cost-effective, accurate, and reliable method for screening for diabetic retinopathy. The American Telemedicine Association has set up guidelines for telescreening that should be adhered to provide quality screening services to people with diabetes.     

The cost-effectiveness of technology transfer using telemedicine

The high burden of disease in developing countries often makes it difficult for health systems in these countries to attain the same level of specialist skills as industrialized countries. Technology transfer is one way to improve specialist skills whilst at the same time reducing the burden of disease. This paper describes the use of teleophthalmology, a form of telemedicine, as a mode of technology transfer between the United Kingdom and South Africa. As the burden of eye disease in South Africa is high, the country cannot afford the level of ophthalmic specialization achieved in the UK. The paper estimates the cost-effectiveness of the technology transfer project in terms of a cost per Disability Adjusted Life Year (DALY) averted. We found the technology transfer project to be cost-effective in reducing the burden of eye disease, and that practitioners in South Africa also learned novel procedures that could help future patients and improve cost-effectiveness. Technology transfer using telemedicine is a cost-effective method that richer countries can employ to aid capacity building in the health care systems of poorer countries.     

Benefits of stereopsis when identifying clinically significant macular edema via teleophthalmology

BACKGROUND: The need to incorporate stereopsis into a teleophthalmology system is controversial. Detection of hard exudate in the macula is suggested by some as an adequate surrogate for direct observation of retinal thickening. This study was designed to determine how accurate the detection of hard exudate is as a surrogate for stereoscopic detection of clinically significant macular edema (CSME).METHODS: 120 patients with diabetes underwent clinical retinal examination with contact-lens biomicroscopy by a retinal specialist. The presence or absence of CSME was recorded. On the same day as clinical grading, 30 degrees stereoscopic digital photographs of the macula were captured. At least 2 months after clinical examination, the digital images were viewed by masked graders for the presence or absence of hard exudate and retinal thickening. RESULTS: 207 eyes of 106 patients had complete data sets for both diagnostic modalities. The sensitivity of hard exudate (93.9%) in predicting the presence of CSME was similar to that of direct stereoscopic observation of retinal thickening (90.9%), with p = 0.5. On the other hand, digital stereopsis was significantly more specific (92.9%) than was hard exudate (81.6%) in predicting the presence of CSME (p < 0.001). This difference was maintained even when controlling for image quality. INTERPRETATION: Although the presence of hard exudate within the macula is a sensitive surrogate marker for CSME, it is less specific than stereoscopic evaluation. Any American Telemedicine Association category 3 teleophthalmology system that utilizes hard exudate as a surrogate marker for CSME may refer patients unnecessarily for clinical evaluation.     

Optometry‐facilitated teleophthalmology: an audit of the first year in Western Australia

Background

Lions Outback Vision has run a state‐wide teleophthalmology service since 2011. In September 2015 the Australian federal government introduced a Medicare reimbursement for optometry‐facilitated teleophthalmology consultations under specific circumstances. This audit demonstrates the first 12 months experience with this scheme. We aim to provide practical insights for others looking to embed a telemedicine program as part of delivering outreach clinical services.

Methods

A 12‐month retrospective audit was performed between September 2015 and August 2016, inclusive. A research officer used a specifically designed data extraction tool to record information from all teleophthalmology consultations performed in the time period. The primary outcome was the diagnosis at the end of the teleophthalmology consultation. Secondary outcome measures included the number of teleconsultations, cataract surgery rate, remoteness area of patients referred and imaging accompanying the referral.

Results

In the 12‐month period, 709 patients were referred resulting in 683 teleophthalmology teleconsultations. Cataract was the most frequent diagnosis (n = 287, 42.7 per cent), followed by glaucoma (n = 77, 11 per cent), age‐related macular degeneration (n = 30, 4.4 per cent) and diabetic retinopathy (n = 26, 3.8 per cent). Of those who had teleconsultations, 98.6 per cent were from Outer Regional, Remote or Very Remote Australia. One or more accompanying images or investigations were part of 349 (49 per cent) teleconsultations, most commonly optical coherence tomography (215, 30 per cent) and fundus photography (148, 21 per cent). Face‐to‐face consultations were undertaken at an outreach clinic in 23 (3.4 per cent) cases, to determine the diagnosis. There were no statistically significant factors associated with attendance at teleophthalmology consultation, or for successfully undergoing cataract surgery.

Conclusion

Teleophthalmology is a valuable adjunct to regional outreach ophthalmology services, providing patients with increased access to specialist care for a wide range of ophthalmic conditions, and more efficient access to surgical care.     

远程眼科眼底像阅片诊断应注意的问题

 为进一步提高远程眼科医疗服务质量,对远程眼科眼底像阅片诊断的认识需要认真梳理。眼底照相机采集图像的质量是决定远程眼科眼底像阅片诊断质量的基础。眼底像位置正确、图像清晰、对焦准确是基本要求。单张眼底像对多种常见致盲性眼病如青光眼、糖尿病视网膜病变、年龄相关性黄斑变性等的筛查及诊断起着极其重要的作用,但其不能发现周边眼底病变,也不能判定病变的立体特性,在缺乏其他临床资料支持的情况下,存在一定的误诊和漏诊风险。基于眼底像的远程会诊眼底病的能力目前仍存在挑战,需制定我国远程眼科会诊服务的分级标准,并对此进行客观而全面的评价。书写眼底像阅片报告时,要重视患者病史及主诉,着重描述有鉴别诊断意义的眼底像体征,慎重进行诊断,多提供一些处理建议。（眼科, 2014, 23： 217-220）     

远程医疗在糖尿病视网膜病变筛查项目中应用的价值及前景

糖尿病视网膜病变(DR)是工作年龄人群中可预防性失明的疾病最常见原因,全球糖尿病人数众多,医疗卫生资源不平衡,患者眼底检查依从性低,DR筛查任务艰巨。远程眼科可通过网络信息技术传输患者医学影像和相关信息至远端医生,增加了偏远地区的糖尿病患者接受及时DR评估的机会。本文应用Wilson和Jungner关于慢性疾病筛查的10个标准评估DR筛查的远程医疗项目,并按照美国远程医疗协会制定的《糖尿病视网膜病变远程医疗实践指南》中筛查项目的临床验证分类,对目前发表的DR远程筛查项目应用研究的概况进行综述分析。     

Machine Learning in the Detection of the Glaucomatous Disc and Visual Field

ABSTRACT

Glaucoma is the leading cause of irreversible blindness worldwide. Early detection is of utmost importance as there is abundant evidence that early treatment prevents disease progression, preserves vision, and improves patients’ long-term quality of life. The structure and function thresholds that alert to the diagnosis of glaucoma can be obtained entirely via digital means, and as such, screening is well suited to benefit from artificial intelligence and specifically machine learning. This paper reviews the concepts and current literature on the use of machine learning for detection of the glaucomatous disc and visual field.     

Use of digital retinal imaging in screening for retinopathy of prematurity

The frequency of premature births is increasing world‐wide. This factor, combined with improved survival and revised screening criteria, is resulting in an increased workload in screening for retinopathy of prematurity. Digital retinal imaging is emerging as an important alternative tool for diagnosing retinopathy of prematurity, and its use has even been extended to developing countries. Neonatal nurses and technicians can be trained to use digital imaging devices effectively. This is important in areas that do not have ready access to paediatric ophthalmologists. The ability to transfer images electronically makes it a valuable tool in telemedicine, while the ability to store and retrieve images is also advantageous from a medico‐legal perspective. Image analysis software can further improve the accuracy of diagnosis. The main limitation of this technology is its high capital cost.     

Impact of teleophthalmology during COVID-19 lockdown in a tertiary care center in South India

Purpose:The aim of this study was to describe the experience of teleconsultations addressed at our hospital in India during the ongoing coronavirus (COVID-19) lockdown.Methods:This cross-sectional hospital-based study included 977 teleconsultations presenting between April 1^st and May 31, 2020. A two-level protocol was implemented to triage the calls.Results:Overall, 977 teleconsultation were addressed. Of the 621 teleconsultation addressed the most common queries were related to redness/pain/ watering/blurred vision/itching/irritation (52.49%), followed by queries related to medications (28.01%), appointments (18.84%) & 0.64% cited an emergency need to visit the hospital due to sudden loss of vision. The majority of the queries were directed to the department of cornea (58.93%) followed by retina (16.26%), cataract (13.04%), glaucoma (10.14%) & pediatric ophthalmology (1.61%). The most common advice given to the patient was related to medications (47.66%) followed by appointment-related queries (31.72%) & fixing of surgical appointment (20.61%). Among the 356 preterm babies that were screened, 57 (16.01%) were diagnosed with retinopathy of prematurity (ROP). Of them 3 required laser and 3 were given injection.Conclusion:Teleconsultation is here to stay beyond the pandemic. WhatsApp was the preferred modality of communication for us. Teleophthalmology has given us insights to use this evolving technology to reach out to the population at large to provide eye care services. We believe that this mode of teleophthalmology has helped us in providing feasible eye care to the patients.