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Greenup EP, Page M, Best D, Best T, Gibbs C. Patterns in the Use of Emergency Telemedicine Support in the Management of Traumatic Road Crashes. Telemed J E Health 2024; 30:579-584. [PMID: 37624653 DOI: 10.1089/tmj.2023.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Objective: The introduction of emergency telemedicine care models is a common theme in health jurisdictions that include rural and remote populations. How the availability of these models influences the way clinicians manage traumatic road crashes is not yet fully understood. This study seeks to compare road crashes where telemedicine was and was not used and to identify any variables that may increase the likelihood of telemedicine usage by treating clinicians. Methods: Road crashes reported in the state Department of Transport and Main Roads (Queensland, Australia) crash database between January 1, 2019, and November 30, 2020 (n = 23,734) were compared to videoconferencing call logs to determine which crashes resulted in treatment that was supported by telemedicine (n = 204). Analysis was performed to examine differences in characteristics related to the crash depending on whether telemedicine support was requested. Results: Road crashes where telemedicine support was requested on average involved more casualties (1.6 vs. 1.41; t(11,287) = -3.26, p < 0.001, relative risk = 1.13). Crashes that occurred in rural settings accounted for most requests for telemedicine (65.68%; X2 = 159.2, p < 0.001) and a greater percentage of crashes in remote locations (3.36% vs. 2.35%; X2 = 256.97, p < 0.001, relative risk = 1.43). The use of telemedicine support for crashes was associated with a 13% increase in the mean number of casualties, compared to crashes where telemedicine support was not used. Conclusion: Telemedicine support is requested by clinicians providing emergency treatment in the management of road crashes that produce more severe injuries, involve multiple casualties, and take place in more rural settings or remote locations.
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Affiliation(s)
| | - Matthew Page
- Clinical Excellence Queensland, Queensland Health, Brisbane, Australia
| | - Daniel Best
- Clinical Excellence Queensland, Queensland Health, Brisbane, Australia
| | - Tiffany Best
- Retrieval Services Queensland, Queensland Health, Brisbane, Australia
| | - Clinton Gibbs
- Retrieval Services Queensland, Queensland Health, Brisbane, Australia
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Dolar-Szczasny J, Barańska A, Rejdak R. Evaluating the Efficacy of Teleophthalmology in Delivering Ophthalmic Care to Underserved Populations: A Literature Review. J Clin Med 2023; 12:jcm12093161. [PMID: 37176602 PMCID: PMC10179149 DOI: 10.3390/jcm12093161] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Technological advancement has brought commendable changes in medicine, advancing diagnosis, treatment, and interventions. Telemedicine has been adopted by various subspecialties including ophthalmology. Over the years, teleophthalmology has been implemented in various countries, and continuous progress is being made in this area. In underserved populations, due to socioeconomic factors, there is little or no access to healthcare facilities, and people are at higher risk of eye diseases and vision impairment. Transportation is the major hurdle for these people in obtaining access to eye care in the main hospitals. There is a dire need for accessible eye care for such populations, and teleophthalmology is the ray of hope for providing eye care facilities to underserved people. Numerous studies have reported the advantages of teleophthalmology for rural populations such as being cost-effective, timesaving, reliable, efficient, and satisfactory for patients. Although it is being practiced in urban populations, for rural populations, its benefits amplify. However, there are certain obstacles as well, such as the cost of equipment, lack of steady electricity and internet supply in rural areas, and the attitude of people in certain regions toward acceptance of teleophthalmology. In this review, we have discussed in detail eye health in rural populations, teleophthalmology, and its effectiveness in rural populations of different countries.
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Affiliation(s)
- Joanna Dolar-Szczasny
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
| | - Agnieszka Barańska
- Department of Medical Informatics and Statistics with E-Learning Laboratory, Medical University of Lublin, 20-090 Lublin, Poland
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
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Kiburg KV, Turner A, He M. Telemedicine and delivery of ophthalmic care in rural and remote communities: Drawing from Australian experience. Clin Exp Ophthalmol 2022; 50:793-800. [PMID: 35975938 DOI: 10.1111/ceo.14147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 01/07/2023]
Abstract
Rural and remote communities in Australia are characterised by small but widely dispersed populations. This has been proven to be a major hurdle in access to medical care services with screening and treatment goals repeatedly being missed. Telemedicine in ophthalmology provides the opportunity to increase the availability of high quality and timely access to healthcare within. Recent years has also seen the introduction of artificial intelligence (AI) in ophthalmology, particularly in the screening of diseases. AI will hopefully increase the number of appropriate referrals, reduce travel time for patients and ensure timely triage given the low number of qualified optometrists and ophthalmologists. Telemedicine and AI has been introduced in a number of countries and has led to tremendous benefits and advantages when compared to standard practices. This paper summarises current practices in telemedicine and AI and the future of this technology in improving patient care in the field of ophthalmology.
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Affiliation(s)
- Katerina V Kiburg
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Angus Turner
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Castner J, Bell SA, Hetland B, Der-Martirosian C, Castner M, Joshi AU. National Estimates of Workplace Telehealth Use Among Emergency Nurses and All Registered Nurses in the United States. J Emerg Nurs 2022; 48:45-56. [PMID: 34656361 PMCID: PMC9881547 DOI: 10.1016/j.jen.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The goal of this research was to quantify the baseline status of prepandemic workplace emergency nursing telehealth as a key consideration for ongoing telehealth growth and sustainable emergency nursing care model planning. The purpose of this research was to: (1) generate national estimates of prepandemic workplace telehealth use among emergency and other inpatient hospital nurses and (2) map the geographic distribution of prepandemic workplace emergency nurse telehealth use by state of nurse residence. METHODS We generated national estimates using data from the 2018 National Sample Survey of Registered Nurses. Data were analyzed using jack-knife estimation procedures coherent with the complex sampling design selected as representative of the population and requiring analysis with survey weights. RESULTS Weighted estimates of the 161 865 emergency nurses, compared with 1 191 287 other inpatient nurses revealed more reported telehealth in the workplace setting (49% vs 34%) and individual clinical practice telehealth use (36% vs 15%) among emergency nurses. The geographic distribution of individual clinical practice emergency nurse telehealth use indicates greatest adoption per 10 000 state residents in Maine, Alaska, and Missouri with more states in the Midwest demonstrating emergency nurse adoption of telehealth into clinical practice per population than other regions in the United States. DISCUSSION By quantifying prepandemic national telehealth use, the results provide corroborating evidence to the potential long-term adoptability and sustainability of telenursing in the emergency nursing specialty. The results also implicate the need to proactively define emergency nursing telehealth care model standards of practice, nurse competencies, and reimbursement.
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Walsh L, Hong SC, Chalakkal RJ, Ogbuehi KC. A Systematic Review of Current Teleophthalmology Services in New Zealand Compared to the Four Comparable Countries of the United Kingdom, Australia, United States of America (USA) and Canada. Clin Ophthalmol 2021; 15:4015-4027. [PMID: 34675470 PMCID: PMC8500493 DOI: 10.2147/opth.s294428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022] Open
Abstract
Background Over 700,000 New Zealanders (NZ), particularly elderly and Māori, live without timely access to specialist ophthalmology services. Teleophthalmology is a widely recognised tool that can assist in overcoming resource and distance barriers. Teleophthalmology gained unprecedented traction in NZ during the COVID-19 pandemic and subsequent lockdown. However, its provision is still limited and there are equity issues. The aim of this study was to conduct a systematic review identifying, describing and contrasting teleophthalmology services in NZ with the comparable countries of Australia, USA, Canada and the United Kingdom. Methods The electronic databases Embase, PubMed, Web of Science, Google Scholar and Google were systemically searched using the keywords: telemedicine, ophthalmology, tele-ophthalmology/teleophthalmology. The searches were filtered to the countries above, with no time constraints. An integrative approach was used to synthesise findings. Results One hundred and thirty-two studies were identified describing 90 discrete teleophthalmology services. Articles spanned from 1997 to 2020. Models were categorised into general eye care (n=21; 16%); emergency/trauma (n=6; 4.5%); school screening (n=25; 19%); artificial intelligence (AI) (n=23; 18%); and disease-specific models of care (MOC) (n=57; 43%). The most common diseases addressed were diabetic retinopathy (n=23; 17%); retinopathy of prematurity (n=9; 7%); and glaucoma (n=8; 6%). Programs were mainly centred in the US (n=72; 54.5%), followed by the UK (n=29; 22%), then Canada (n=16; 12%), Australia (n=13; 10%), with the fewest identified in NZ (n=3; 2%). Models generally involved an ophthalmologist consultative service, remote supervision and triaging. Most models involved local clinicians transmitting fed-forward or live images. Conclusion Teleophthalmology will likely play a crucial role in the future of eye care. COVID-19 has offered a unique opportunity to observe the use of teleophthalmology services globally. Feed-forward and, increasingly, live-based teleophthalmology services have demonstrated feasibility and cost-effectiveness in similar countries internationally. New Zealand’s teleophthalmology services, however, are currently limited. Investing in strategic partnerships and technology at a national level can advance health equities in ophthalmic care.
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Affiliation(s)
- Liam Walsh
- Department of Ophthalmology, Southern District Health Board, Dunedin, Otago, New Zealand
| | - Sheng Chiong Hong
- Department of Ophthalmology, Southern District Health Board, Dunedin, Otago, New Zealand
| | - Renoh Johnson Chalakkal
- Research and Development, oDocs Eye Care, Dunedin, Otago, New Zealand.,Electrical and Computer Engineering, University of Auckland, Auckland, New Zealand
| | - Kelechi C Ogbuehi
- Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
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6
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 472] [Impact Index Per Article: 157.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
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Sim SS, Yip MY, Wang Z, Tan ACS, Tan GSW, Cheung CMG, Chakravarthy U, Wong TY, Teo KYC, Ting DS. Digital Technology for AMD Management in the Post-COVID-19 New Normal. Asia Pac J Ophthalmol (Phila) 2021; 10:39-48. [PMID: 33512827 DOI: 10.1097/apo.0000000000000363] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has put strain on healthcare systems and the availability and allocation of healthcare manpower, resources and infrastructure. With immediate priorities to protect the health and safety of both patients and healthcare service providers, ophthalmologists globally were advised to defer nonurgent cases, while at the same time managing sight-threatening conditions such as neovascular Age-related Macular Degeneration (AMD). The management of AMD patients both from a monitoring and treatment perspective presents a particular challenge for ophthalmologists. This review looks at how these pressures have encouraged the acceptance and speed of adoption of digitalization. DESIGN AND METHODS A literature review was conducted on the use of digital technology during COVID-19 pandemic, and on the transformation of medicine, ophthalmology and AMD screening through digitalization. RESULTS In the management of AMD, the implementation of artificial intelligence and "virtual clinics" have provided assistance in screening, diagnosis, monitoring of the progression and the treatment of AMD. In addition, hardware and software developments in home monitoring devices has assisted in self-monitoring approaches. CONCLUSIONS Digitalization strategies and developments are currently ongoing and underway to ensure early detection, stability and visual improvement in patients suffering from AMD in this COVID-19 era. This may set a precedence for the post COVID-19 new normal where digital platforms may be routine, standard and expected in healthcare delivery.
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Affiliation(s)
- Shaun Sebastian Sim
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Michelle Yt Yip
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Zhaoran Wang
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Anna Cheng Sim Tan
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Usha Chakravarthy
- Queen's University of Belfast Royal Victoria Hospital, Belfast, Ireland
| | - Tien Yin Wong
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kelvin Yi Chong Teo
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Daniel Sw Ting
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
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8
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Maa AY, Medert CM, Lu X, Janjua R, Howell AV, Hunt KJ, McCord S, Giangiacomo A, Lynch MG. Diagnostic Accuracy of Technology-based Eye Care Services. Ophthalmology 2020; 127:38-44. [DOI: 10.1016/j.ophtha.2019.07.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/01/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022] Open
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9
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Quality and Feasibility of Automated Digital Retinal Imaging in the Emergency Department. J Emerg Med 2019; 58:18-24. [PMID: 31718881 DOI: 10.1016/j.jemermed.2019.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Emergency physicians (EPs) frequently evaluate patients at risk for sight-threatening conditions but may have difficulty performing direct ophthalmoscopy effectively. Digital fundus photography offers a potential alternative. OBJECTIVE We sought to assess the performance of an automated digital retinal imaging platform in a real-world emergency department. METHODS We performed a prospective, observational study of emergency department patients who were at risk for acute, nontraumatic, posterior segment pathology. Photographs were obtained using an automated digital retinal camera and were subsequently reviewed by an ophthalmologist. We recorded the number of attempts required, total time required, patient comfort, and findings on EP-performed direct ophthalmoscopy, if performed. RESULTS Of 123 participants completing the study, 93 (75.6%) had ≥1 eye with a diagnostically useful image, while 29 (23.6%) had no photographs of diagnostic value. The mean number of attempts required to obtain images was 1.45 (range 1-3) and the mean elapsed time required to complete photography was 109.6 s. The mean patient comfort score was 4.6 on a 5-point scale, where 5 was the most comfortable. Direct ophthalmoscopy was performed by an emergency department provider for 19 (15.4%) patients. Acute findings were noted in 14 patients during expert review of fundus photographs, though in only 2 of these cases was direct ophthalmoscopy performed by an EP with only 1 finding ultimately identified correctly. CONCLUSIONS Automated digital imaging of the ocular fundus is rapidly performed, is well tolerated by patients, and can be used to obtain diagnostic quality images without the use of pharmacologic pupillary dilation in most emergency department patients who are at risk for acute posterior segment pathology.
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10
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McCord SA, Lynch MG, Maa AY. Diagnosis of retinal detachments by a tele-ophthalmology screening program. J Telemed Telecare 2018; 25:190-192. [PMID: 29486624 DOI: 10.1177/1357633x18760418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.
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Affiliation(s)
- Sarah A McCord
- 1 Department of Ophthalomology, Emory University, School of Medicine, USA
| | - Mary G Lynch
- 1 Department of Ophthalomology, Emory University, School of Medicine, USA.,2 Eye Clinic, Atlanta Veterans Affairs Medical Center, USA
| | - April Y Maa
- 1 Department of Ophthalomology, Emory University, School of Medicine, USA.,2 Eye Clinic, Atlanta Veterans Affairs Medical Center, USA
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11
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Caffery LJ, Taylor M, Gole G, Smith AC. Models of care in tele-ophthalmology: A scoping review. J Telemed Telecare 2017; 25:106-122. [DOI: 10.1177/1357633x17742182] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The objective of this review was to identify and describe telehealth models of care for ophthalmic services. We conducted a scoping review of the literature to identify how ophthalmic care can be delivered by telehealth. We searched the PubMed database to identify relevant articles which were screened based on pre-defined inclusion criteria. For included articles, data were extracted, categorised and analysed. Synthesis of findings was performed narratively. The scoping review included 78 articles describing 62 discrete tele-ophthalmic models of care. Tele-ophthalmic models of care can be used for consultative service, screening, triage and remote supervision. The majority of services were for general eye care and triage ( n = 17; 26%) or emergency services ( n = 8; 12%). The most common conditions for disease-specific models of care were diabetic retinopathy ( n = 14; 21%), and glaucoma ( n = 8; 12%). Most models of care involved local clinicians capturing images and transmitting them to an ophthalmologist for assessment. This scoping review demonstrated tele-ophthalmology to be feasible for consultation, screening, triage and remote supervision applications across a broad range of ophthalmic conditions. A large number of models of care have been identified and described in this review. Considerable collaboration between patient-end clinicians and substantial infrastructure is typically required for tele-ophthalmology.
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Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
| | - Monica Taylor
- Centre for Online Health, The University of Queensland, Australia
| | - Glen Gole
- Children’s Health Queensland, Queensland Children’s Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
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12
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du Toit M, Malau-Aduli B, Vangaveti V, Sabesan S, Ray RA. Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: A systematic review. J Telemed Telecare 2017; 25:3-16. [PMID: 28980853 DOI: 10.1177/1357633x17734239] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Telehealth has been used extensively in emergency departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote emergency department settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. METHODS Articles were identified through database searches of CINAHL, Cochrane, MEDLINE (OVID), Informit and SCOPUS, as well as the screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies, information was extracted relating to telehealth programme model, the scope of service and participating health professionals. The outcomes of telehealth programmes were determined by analysing the uptake and usage of telehealth, the impact on altering a diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. RESULTS Of the 2532 identified records, 15 were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programmes predominantly utilised by nursing staff with limited local medical support. Teleconsultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and fewer patients were discharged home. Discharge against medical advice rates were low at 0.9-1.1%. CONCLUSION The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programmes may assist in reducing unnecessary patient transfer and secondary overtriage, while increasing the capacity of emergency department staff to diagnose and manage patients locally, which may translate into increased local hospital admission and reduced discharge rates following teleconsultation.
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Affiliation(s)
- Marie du Toit
- 1 College of Medicine and Dentistry, James Cook University, Australia
| | - Bunmi Malau-Aduli
- 1 College of Medicine and Dentistry, James Cook University, Australia
| | - Venkat Vangaveti
- 1 College of Medicine and Dentistry, James Cook University, Australia
| | - Sabe Sabesan
- 1 College of Medicine and Dentistry, James Cook University, Australia.,2 Department of Medical Oncology, Townsville Hospital, Australia
| | - Robin A Ray
- 1 College of Medicine and Dentistry, James Cook University, Australia
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Woodward MA, Musch DC, Hood CT, Greene JB, Niziol LM, Jeganathan VSE, Lee PP. Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability. Cornea 2017; 36:1159-1165. [PMID: 28820791 PMCID: PMC5646384 DOI: 10.1097/ico.0000000000001294] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Corneal and anterior segment diseases cause most of the urgent visits to eye care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from 2 portable cameras for telemedicine purposes. METHODS This is a prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A cornea specialist provided the gold standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for the presence of pathology. Accuracy to detect disease was compared with gold standard diagnosis, stratified by the camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal). RESULTS A total of 198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54% to 71% for the iTouch and 66% to 75% for the Nidek, across graders; specificity ranged from 82% to 96% for the iTouch and 91% to 98% for the Nidek. The intergrader reliability was moderate to strong (kappa ranges: 0.54-0.71 for the iTouch; 0.75-0.76 for the Nidek). Quality ratings were variable between graders. CONCLUSIONS External photographs taken by standard, nonenhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.
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Affiliation(s)
- Maria A Woodward
- *Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and ‡Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
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Maa AY, Wojciechowski B, Hunt KJ, Dismuke C, Shyu J, Janjua R, Lu X, Medert CM, Lynch MG. Early Experience with Technology-Based Eye Care Services (TECS): A Novel Ophthalmologic Telemedicine Initiative. Ophthalmology 2017; 124:539-546. [PMID: 28081944 DOI: 10.1016/j.ophtha.2016.11.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The aging population is at risk of common eye diseases, and routine eye examinations are recommended to prevent visual impairment. Unfortunately, patients are less likely to seek care as they age, which may be the result of significant travel and time burdens associated with going to an eye clinic in person. A new method of eye-care delivery that mitigates distance barriers and improves access was developed to improve screening for potentially blinding conditions. We present the quality data from the early experience (first 13 months) of Technology-Based Eye Care Services (TECS), a novel ophthalmologic telemedicine program. DESIGN With TECS, a trained ophthalmology technician is stationed in a primary care clinic away from the main hospital. The ophthalmology technician follows a detailed protocol that collects information about the patient's eyes. The information then is interpreted remotely. Patients with possible abnormal findings are scheduled for a face-to-face examination in the eye clinic. PARTICIPANTS Any patient with no known ocular disease who desires a routine eye screening examination is eligible. METHODS Technology-Based Eye Care Services was established in 5 primary care clinics in Georgia surrounding the Atlanta Veterans Affairs hospital. MAIN OUTCOME MEASURES Four program operation metrics (patient satisfaction, eyeglass remakes, disease detection, and visit length) and 2 access-to-care metrics (appointment wait time and no-show rate) were tracked. RESULTS Care was rendered to 2690 patients over the first 13 months of TECS. The program has been met with high patient satisfaction (4.95 of 5). Eyeglass remake rate was 0.59%. Abnormal findings were noted in 36.8% of patients and there was >90% agreement between the TECS reading and the face-to-face findings of the physician. TECS saved both patient (25% less) and physician time (50% less), and access to care substantially improved with 99% of patients seen within 14 days of contacting the eye clinic, with a TECS no-show rate of 5.2%. CONCLUSIONS The early experience with TECS has been promising. Tele-ophthalmology has the potential to improve operational efficiency, reduce cost, and significantly improve access to care. Although further study is necessary, TECS shows potential to help prevent avoidable vision loss.
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Affiliation(s)
- April Y Maa
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
| | - Barbara Wojciechowski
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Kelly J Hunt
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Clara Dismuke
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Jason Shyu
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Rabeea Janjua
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Xiaoqin Lu
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | | | - Mary G Lynch
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
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15
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Maa AY, Patel S, Chasan JE, Delaune W, Lynch MG. Retrospective Evaluation of a Teleretinal Screening Program in Detecting Multiple Nondiabetic Eye Diseases. Telemed J E Health 2017; 23:41-48. [DOI: 10.1089/tmj.2016.0039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- April Y. Maa
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Shivangi Patel
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
| | - Joel E. Chasan
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - William Delaune
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, Georgia
| | - Mary G. Lynch
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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16
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Glasper A. Expanding the use of digital technology across the NHS. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:1078-1079. [PMID: 27792434 DOI: 10.12968/bjon.2016.25.19.1078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Emeritus Professor Alan Glasper, from the University of Southampton, discusses the Government's ambition to roll out advances in digital healthcare technology to improve patient care in the NHS.
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Jacobsen B, Lahham S, Lahham S, Patel A, Spann S, Fox JC. Retrospective Review of Ocular Point-of-Care Ultrasound for Detection of Retinal Detachment. West J Emerg Med 2016; 17:196-200. [PMID: 26973752 PMCID: PMC4786246 DOI: 10.5811/westjem.2015.12.28711] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/21/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Retinal detachment is an ocular emergency that commonly presents to the emergency department (ED). Ophthalmologists are able to accurately make this diagnosis with a dilated fundoscopic exam, scleral depression or ophthalmic ultrasound when a view to the retina is obstructed. Emergency physicians (EPs) are not trained to examine the peripheral retina, and thus ophthalmic ultrasound can be used to aid in diagnosis. We assessed the accuracy of ocular point-of-care ultrasound (POCUS) in diagnosing retinal detachment. Methods We retrospectively reviewed charts of ED patients with suspected retinal detachment who underwent ocular POCUS between July 2012 and May 2015. Charts were reviewed for patients presenting to the ED with ocular complaints and clinical concern for retinal detachment. We compared ocular POCUS performed by EPs against the criterion reference of the consulting ophthalmologist’s diagnosis. Results We enrolled a total of 109 patients. Of the 34 patients diagnosed with retinal detachment by the ophthalmologists, 31 were correctly identified as having retinal detachment by the EP using ocular POCUS. Of the 75 patients who did not have retinal detachment, 72 were ruled out by ocular POCUS by the EP. This resulted in a POCUS sensitivity of 91% (95% CI [76–98]) and specificity of 96% (95% CI [89–99]). Conclusion This retrospective study suggests that ocular POCUS performed by EPs can aid in the diagnosis of retinal detachment in ED.
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Affiliation(s)
- Bradley Jacobsen
- University of California Irvine School of Medicine, Irvine, California
| | - Sari Lahham
- University of California Irvine School of Medicine, Irvine, California
| | - Shadi Lahham
- University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California
| | - Amy Patel
- University of California Irvine, Gavin Herbert Eye Institute, Department of Ophthalmology, Irvine, California
| | - Sophia Spann
- University of California Irvine, Department of Emergency Medicine, Orange, California
| | - John C Fox
- University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California
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18
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Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2015; 33:228-34. [PMID: 24493765 DOI: 10.1377/hlthaff.2013.1016] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.
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Johnson KA, Meyer J, Yazar S, Turner AW. Real-time teleophthalmology in rural Western Australia. Aust J Rural Health 2015; 23:142-9. [DOI: 10.1111/ajr.12150] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Karim A. Johnson
- Centre for Ophthalmology & Visual Science (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
| | - Joos Meyer
- Centre for Ophthalmology & Visual Science (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
| | - Seyhan Yazar
- Centre for Ophthalmology & Visual Science (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
| | - Angus W. Turner
- Centre for Ophthalmology & Visual Science (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
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20
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Maa AY, Evans C, DeLaune WR, Patel PS, Lynch MG. A novel tele-eye protocol for ocular disease detection and access to eye care services. Telemed J E Health 2014; 20:318-23. [PMID: 24527668 DOI: 10.1089/tmj.2013.0185] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telemedicine can improve access to care, especially for rural patients, and ophthalmology is a field that lends itself readily to telemedicine because interpretation of photographs is a routine part of diagnosing eye disease and patient care. We developed a novel tele-eye protocol based on diabetic teleretinal screening. We performed a feasibility study to see if our tele-eye program was comparable to the gold standard face-to-face eye exam. MATERIALS AND METHODS Fifty-two subjects underwent the tele-eye protocol and then received a face-to-face exam. A masked reader reviewed the tele-eye data remotely and developed an impression and plan for the patient. The provider assessments from the face-to-face exams and the tele-eye exams were compared. Sensitivity, specificity, and percentage agreement were calculated for the tele-eye protocol, focusing on the most common age-related eye diseases: cataract, macular degeneration, and glaucoma. The difference between the autorefraction and manifest eyeglass prescription was calculated. RESULTS The pilot study showed excellent percentage agreement between the screening protocol and the face-to-face exam. The percentage agreement for cataract was 100%, that for macular degeneration was 96%, and that for glaucoma suspect was 87%. The difference between the autorefraction's eyeglass prescription and the final manifest refraction was within American National Standards Institute for lens manufacturing guidelines. CONCLUSIONS The initial data suggest that the tele-eye program is feasible to execute and appears fairly accurate when compared with the gold standard face-to-face eye exam. However, the study is significantly limited by the small sample size. This pilot provides justification of a much larger study of a similar design.
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Affiliation(s)
- April Y Maa
- 1 Department of Ophthalmology, Emory Eye Center , Atlanta, Georgia
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Bruce BB, Lamirel C, Biousse V, Ward A, Heilpern KL, Newman NJ, Wright DW. Feasibility of nonmydriatic ocular fundus photography in the emergency department: Phase I of the FOTO-ED study. Acad Emerg Med 2011; 18:928-33. [PMID: 21906202 DOI: 10.1111/j.1553-2712.2011.01147.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by nonophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of nonmydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). METHODS Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mm Hg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a nonmydriatic fundus camera. Photographs were reviewed by a neuroophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of nonmydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. RESULTS A total of 350 patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high-quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] = 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient's total ED visit. CONCLUSIONS Nonmydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by nonphysician staff, is well-received by staff and patients, and requires a trivial amount of time to perform.
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Affiliation(s)
- Beau B Bruce
- Department of Ophthalmology, Emory University, Atlanta, GA, USA.
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23
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Brebner JA, Brebner EM, Ruddick-Bracken H. Accident and emergency teleconsultation for primary care--a systematic review of technical feasibility, clinical effectiveness, cost effectiveness and level of local management. J Telemed Telecare 2007; 12 Suppl 1:5-8. [PMID: 16884562 DOI: 10.1258/135763306777978542] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A systematic review of accident and emergency teleconsultation services was carried out. Studies (English language only) conducted worldwide and published between 1996 and 2003 were included. Evidence relating to technical feasibility, clinical effectiveness, cost effectiveness and level of local management was used as the main outcome measure. Thirty-one studies met the selection criteria. Only two studies were randomized controlled studies. All studies provided evidence that that the service was technically feasible. Of the studies, 97% suggested that the service was clinically effective; 48% (15) of the studies gave figures for the level of local management achieved. The range for local management was 35-100% with a mean of 76%. Only 23% of the studies provided evidence to suggest that the service was cost effective. The case for cost-effectiveness is far from proven and this area of research requires immediate attention if potential users are to be convinced of the value of telemedicine.
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Affiliation(s)
- John A Brebner
- Telemedicine Laboratory, Remote Health Care Unit, Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK.
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Paul PG, Raman R, Rani PK, Deshmukh H, Sharma T. Patient satisfaction levels during teleophthalmology consultation in rural South India. Telemed J E Health 2006; 12:571-8. [PMID: 17042711 DOI: 10.1089/tmj.2006.12.571] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The application of new technologies for analysis of retinal images, neural networks for automated retinopathy grading, and teleophthalmology have been shown to have great value in ophthalmology. India has only one ophthalmic surgeon for every 107,000 population. Given this situation, teleophthalmology can play a vital role in addressing to the eye care needs of the country. The objective of this study was to assess patient satisfaction levels and factors influencing it during teleophthalmology consultation in India. A patient satisfaction questionnaire was prepared to assess the prominent aspects of patient satisfaction, including teleophthalmology screening, confidence in the technology used to transfer the fundus images, comprehensiveness of information available to the doctor in the central hub, and graded the opinion regarding the teleophthalmology. A cross-sectional survey among patients who attended a teleophthalmology screening conducted across eight villages in rural Tamilnadu. Responses were then subjected to qualitative analysis and conclusions made. The number of respondents was 348. Of this, 56.4% were males. The mean age of was 50 +/- 17 years. Age ranged from 2 years to 83 years. 44.4% of the respondents were satisfied with teleophthalmology screening. (95% confidence interval [CI]: 38.58%-49.42%) No association was found between age, gender, education, and occupation, respectively, with satisfaction levels. We found that patients who asked questions during the screening were 2.18 times more likely to be satisfied with teleophthalmology than those who did not (odds ratio [OR] = 2.19, 95% CI 1.37-3.5). This study highlights sentiments of the rural subjects when they underwent teleophthalmology consultations. This study provides valuable insights about patient's preferences and satisfaction levels with this newer technology.
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Affiliation(s)
- Pradeep G Paul
- Department of Ophthalmic Epidemiology, Sankara Nethralaya, Chennai, India
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Kumar S, Yogesan K, Hudson B, Tay-Kearney ML, Constable IJ. Emergency eye care in rural Australia: role of internet. Eye (Lond) 2005; 20:1342-4. [PMID: 16179932 DOI: 10.1038/sj.eye.6702104] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Significant differences exist in the utilization of emergency eye care services in rural and urban Australia. Meanwhile, influence of internet-based technology in emergency eye care service utilization has not been established. This study aims to demonstrate, from a health provider perspective, an internet-based service's impact on emergency eye care in rural Australia. METHODS The teleophthalmology service was initiated in the Carnarvon Regional Hospital (CRH) of the Gascoyne region in Western Australia. A digital, slit lamp and fundus camera were used for the service. Economic data was gathered from the Department of Health of Western Australia (DOHWA), the CRH and the Lions Eye Institute. RESULTS During the study period (January-December, 2003) 118 persons took part in teleophthalmology consultations. Emergency cases constituted 3% of these consultations. Previous year, there were seven eye-related emergency evacuations (inter-hospital air transfers) from the Gascoyne region to City of Perth. CONCLUSIONS Analysis demonstrates implementation of internet-based health services has a marked impact on rural emergency eye care delivery. Internet is well suited to ophthalmology for the diagnosis and management of acute conditions in remote areas. Integration of such services to mainstream health care is recommended.
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Affiliation(s)
- S Kumar
- Centre of Excellence in e-Medicine, Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia. sajeesh@ cyllene.uwa.edu.au
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MacFarlane A, Murphy AW, Clerkin P. Telemedicine services in the Republic of Ireland: an evolving policy context. Health Policy 2005; 76:245-58. [PMID: 16026889 DOI: 10.1016/j.healthpol.2005.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 06/11/2005] [Indexed: 11/17/2022]
Abstract
The Republic of Ireland is characterised by few urban conurbations and a high rural population, including significant numbers of island dwellers. Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. As in other countries, the recent National Health Information Strategy is regarded as pivotal to the modernisation of the Irish health care system. There is, however, a dearth of research about telemedicine in Ireland. This paper reports, to the best of our knowledge, the first systematic review of telemedicine in the two regional health boards in the Republic of Ireland. Details of 11 telemedicine services, all initiated by local policy, will be presented. Results of an interview study with service providers about their experiences of the practices and processes involved in telemedicine service delivery are also provided. The focus of our analysis is two-fold. We assess the resonance of these Irish data with the international literature with particular reference to a recently developed model for the normalisation of telemedicine. For the first time, this model which was developed in the United Kingdom is applied to a fresh set of empirical data in a different health care context. We then discuss a number of health information policy issues for Ireland and elsewhere arising from our analysis.
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Affiliation(s)
- Anne MacFarlane
- Department of General Practice, National University of Ireland, Galway, Republic of Ireland.
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Hall G, Hennessy M, Barton J, Coroneo M. Teleophthalmology-Assisted Corneal Foreign Body Removal in a Rural Hospital. Telemed J E Health 2005; 11:79-83. [PMID: 15785224 DOI: 10.1089/tmj.2005.11.79] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper describes two cases of using telementoring from the Prince of Wales Hospital (POWH) Ophthalmology Department, Sydney, to Bourke Base hospital, a rural hospital in far west New South Wales, Australia. Eye trauma occurs frequently in a rural setting, and it can be difficult to assess the extent of the injury without a specialist ophthalmic service. One of the aims of the teleophthalmology is to facilitate the transfer of ophthalmic skills to local health providers such as general practitioners. We demonstrate that the removal of corneal foreign bodies and rust rings can be effectively supervised via teleophthalmology.
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Affiliation(s)
- Geoffrey Hall
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia
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Abstract
A review of the current literature relating to eye health in rural Australia was conducted. Few studies have been undertaken, with most information provided by the Australian Institute of Health and Welfare databases, The National Trachoma and Eye Health Program of 1980 and the Visual Impairment Project in Victoria in the mid 1990s. Key findings were that the rural population has an increased prevalence of pterygium, cataract, ocular trauma and glaucoma, but no difference in refractive error or diabetic retinopathy (although data are limited). Rural residents are more likely to have seen an optometrist but less likely to have seen an ophthalmologist. Interventions have been undertaken in ophthalmologist training to increase the rural workforce and tele-ophthalmology to provide city-based metropolitan ophthalmological support for rural practitioners. Further epidemiological data and evaluated interventions are urgently required to help identify and address the needs of rural Australian communities.
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Affiliation(s)
- Anna C Madden
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
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29
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Rudnisky CJ, Hinz BJ, Tennant MTS, de Leon AR, Greve MDJ. High-resolution stereoscopic digital fundus photography versus contact lens biomicroscopy for the detection of clinically significant macular edema. Ophthalmology 2002; 109:267-74. [PMID: 11825807 DOI: 10.1016/s0161-6420(01)00933-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to compare high-resolution stereoscopic digital photography to contact lens biomicroscopy (CLBM) for the diagnosis of clinically significant macular edema. STUDY DESIGN Comparative, prospective, observational case series. PARTICIPANTS One hundred twenty diabetic patients. METHODS Patients underwent clinical retinal examination with CLBM by a retinal specialist. On the same day as clinical grading, patients received high-resolution stereoscopic digital imaging of the macula. The stereoscopic digital images were viewed using liquid crystal shutter goggles at least 2 months after clinical examination by a single masked grader for the presence or absence of diabetic retinopathy. MAIN OUTCOME MEASURES Presence or absence of the Early Treatment of Diabetic Retinopathy Study criteria for clinically significant macular edema (CSME) overall, CSME 1, CSME 2, CSME 3, macular edema, microaneurysms, intraretinal hemorrhage, and hard exudate. RESULTS Two hundred seven eyes of 105 patients had complete data sets from both diagnostic modalities. Exact agreement was high for all identified pathologic conditions: CSME overall, 83.6%; CSME 1, 83.6%; CSME 2, 96.1%; CSME 3, 88.5%; macular edema, 75.0%; microaneurysms, 77.9%; intraretinal hemorrhage, 83.7%; and hard exudate, 73.1%. Sensitivity ranged from 50.0% (CSME 2) to 90.6% (CSME overall). Specificity ranged from 90.0% (macular edema) to 99.0% (CSME 2). CONCLUSIONS High-resolution stereoscopic digital photography is both sensitive and specific when identifying CSME and correlates well with the accepted standard of CLBM for the diagnosis of CSME.
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Yellowlees PM. Intelligent health systems and third millennium medicine in Australia. TELEMEDICINE JOURNAL : THE OFFICIAL JOURNAL OF THE AMERICAN TELEMEDICINE ASSOCIATION 2000; 6:197-200. [PMID: 10957730 DOI: 10.1089/107830200415117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Lattimore MR. A store-forward ophthalmic telemedicine case report from deployed U. S. Army forces in Kuwait. TELEMEDICINE JOURNAL : THE OFFICIAL JOURNAL OF THE AMERICAN TELEMEDICINE ASSOCIATION 2000; 5:309-13. [PMID: 10908445 DOI: 10.1089/107830299312069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This telemedicine test was developed to determine the relative ease with which an off-the-shelf ophthalmic telemedicine package could be successfully applied from within a remote theatre of operations. The project was conducted at the Camp Doha Health Clinic, located just outside Kuwait City, during the period from April 12(th) through April 23(rd), 1998. The deployed signal unit had contracted for a direct T-1 commercial satellite link (via MCI), which allowed for direct internet connectivity using a PCMCIA network card. Digital images were sent via this connection to 140 e-mail sites throughout the world, including an unsolicited image to each of 134 Army optometry officers for their review, analysis, and diagnosis. Return responses to this unsolicited survey were 53 out of 134, for a 39.7% response rate. Half of the respondents were able to view the image with ease and clarity, rendering an accurate clinical diagnosis. The other half of the respondents either did not have the software to display an image on their clinical desktop PC, or did not know how to use their provided software. This project clearly indicates that an off-the-shelf ophthalmic digital system can be successfully used from a remote deployed site. However, the consulting clinicians require up-to-date training, and their computer packages should have as wide a capability base as possible.
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Affiliation(s)
- M R Lattimore
- Aircrew Health & Performance Division, U.S. Army Aeromedical Research Laboratory, Fort Rucker, Alabama, USA
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Beauregard D, Lewis J, Piccolo M, Bedell H. Diagnosis of glaucoma using telemedicine--the effect of compression on the evaluation of optic nerve head cup-disc ratio. J Telemed Telecare 2000; 6 Suppl 1:S123-5. [PMID: 10793995 DOI: 10.1258/1357633001934401] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A photograph of the optic nerve head requires a lot of disk space (over 1 MByte) for storage and may require substantial bandwidth and time for transmission to a remote practitioner for a second opinion. To test whether compression degrades the image quality of the images, 302 slides were digitized at an optical resolution of 2400 pixels/inch (945 pixels/cm) and 30 bit/pixel. The images were saved both in non-compressed TIFF format and in compressed JPEG (compression ratio of 60) format. A blinded observer measured the optic nerve head cup-disc ratio for all three groups: the original slides, uncompressed TIFF and compressed JPEG images. The results showed that digital images were less accurate than slides. However, compression, even up to a ratio of 40, did not make matters worse.
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Affiliation(s)
- D Beauregard
- College of Optometry, University of Houston, Texas, USA.
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Lin JC. Applying telecommunication technology to health-care delivery. IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE : THE QUARTERLY MAGAZINE OF THE ENGINEERING IN MEDICINE & BIOLOGY SOCIETY 1999; 18:28-31. [PMID: 10429899 DOI: 10.1109/51.775486] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J C Lin
- EECS and Bioengineering Departments, University of Illinois at Chicago,
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Abstract
Technology to create and move multimedia medical information is creating alternatives to physically transporting patients and health care professionals. Teletechnology is a physician extender, both supplementing and reinventing traditional health care delivery systems. The potential of comprehensive teleophthalmology is compelling. This article provides a historical perspective of telemedicine, describes various teleophthalmology systems, and surveys teleophthalmology in clinical consultation, research, and education programs around the world. It also discusses basic issues in applying teleophthalmology to public health.
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Affiliation(s)
- H K Li
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston 77555-0787, USA
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