Tele-ophthalmology is the modern day, cost-effective solution to reach out to the millions of patients, living in the rural and remote areas, who have no access to quality eye care. Dr Shroff’s Charity Eye Hospital has established digital medical equipment and telecommunication technology in its vision centers located in far-flung areas. The ophthalmologists, based at the hospital (tertiary as well as secondary), can now examine the eyes and diagnose eye infections and other conditions requiring medical treatment of patients from such areas, thereby reducing the economic burden on the poor patients.
“Tele-ophthalmology is a branch of tele-medicine that delivers eye care through digital medical equipment and telecommunications technology.”
It is evolving into an integral clinical tool in the healthcare system of the country. It allows clinicians to provide quality health care outside of clinics, thus improving access to medical care, patient outcomes, and overall patient satisfaction. Eye screenings are conducted within the community, often in schools and health fairs. Bringing the clinic directly to the patients allows health professionals to capture more vision-threatening diseases (VTD) such as diabetic retinopathy, glaucoma, age-related macular degeneration, and cataract. By detecting VTD’s early on, tele-ophthalmology allows for timely referral to appropriate experts and consequently, earlier treatment.
Screening sites may not have the comprehensive eye examination equipment readily available in a permanent clinical facility, such as slit lamps, phoropters, and other imaging equipment.3 However, on-site screenings may utilize smaller footprint equipment including an automated refractor, non-contact tonometer, non-mydriatic retinal camera, and optical coherence tomography. Often, screenings are advertised to the local community via email, newsletters, or by word of mouth. A qualified ophthalmologist, known as the reader, is available either in person or remotely to interpret the data collected and develop an assessment and treatment plan for the screened patient.
Tele-ophthalmology has the potential to improve ophthalmic care and diagnose VTDs.1 Ultimately, the goal of tele-ophthalmology is to decrease the global burden of vision-threatening disease and improve the quality of life for patients with eye diseases worldwide.
Tele-ophthalmology services can be provided primarily in two ways synchronously or asynchronously:
Synchronous tele-ophthalmology enables real-time interaction between participants (using standard telemedicine technologies e.g. video/skype -conferencing), synchronous to supervise the removal of corneal foreign bodies and for consultations.
Asynchronous tele-ophthalmology in a “store-and-forward” method, where data is captured and transmitted for review at a later time.
Images of the eye can be captured non-invasively through various methods, generally by a Vision technician or Optometrist professional.
External eye: standard digital stills or video camera
Anterior segment: slit lamp connected to a camera
Posterior segment retina: fundus camera
Mydriasis (pupil dilation, e.g. using tropicamide) may be required to obtain an image of sufficient quality. Stereoscopy may be used to detect retinal thickening. The image can then be transferred, over the Internet or dedicated network to a physician for immediate examination, or for storage and later review. Ideally, the image is encrypted or anonymized for transmission, to protect patient confidentiality. Between image capture and viewing, image processing may be done, including compression, enhancement, and edge-detection. Image evaluation, to detect pathology in the case of asynchronous evaluation, is often done by an ophthalmologist, optometrist or primary care physician, though it is also performed by specially trained staff. Image evaluation may also be automated to provide pathology detection or grading.
Tele-ophthalmology Network of Dr Shroff’s Charity Eye Hospital