Chapter 7: Teleophthalmology

PG is a 56-year-old male with a 17-year history of suboptimally controlled type 2 diabetes mellitus. He has always had good vision and requires only over-the-counter reading glasses. Because of the inconvenience of having his pupils dilated and because he has no vision symptoms, he has not had an eye examination for diabetic retinopathy in more than 7 years. Recently his primary care physician began offering screening evaluations for diabetic retinopathy. At a regularly scheduled primary care follow-up visit, PG elected to have nonmydriatic (with undilated pupils) retinal photographs taken. The images were sent to a remote reading center for evaluation by an ophthalmologist. A report was returned to the primary care physician the next day with a diagnosis of high-risk proliferative diabetic retinopathy in the right eye and severe nonproliferative diabetic retinopathy in the left eye ( Figure 7-1 ). He was immediately referred to a retina specialist and underwent panretinal laser photocoagulation in the right eye within the following 2 weeks. He now understands the severity of his eye disease and regularly returns to his retina specialist for follow-up and management of his diabetic retinopathy.

Without treatment, half of patients with proliferative diabetic retinopathy will lose their vision within 2 years. Individuals treated with panretinal photocoagulation reduce the risk of severe vision loss by 50% compared with untreated patients with the same severity of disease. Clearly having access to telemedicine diabetic retinopathy screening had a significant impact on the likelihood of preserving vision in this patient.

Teleophthalmology allows for the delivery of eye care at a distance using telecommunications technology to transmit information to a remote eye care provider. Teleophthalmology is an excellent example of the alignment of telemedicine with the Triple Aim health policy, a benchmark for health care reform in the United States. ¹ The Triple Aim objectives are to 1) improve the health of populations, 2) improve the patient experience of their care, and 3) reduce per capita cost of health care. Although teleophthalmology is still in the relatively early stages of adoption, there is clear evidence that it is a useful adjunct to traditional face-to-face eye care in achieving the Triple Aim goals. This chapter outlines the current status of teleophthalmology and ocular telehealth, including the common modalities and technologies being used. Validation, quality assurance, reimbursement and practice recommendations, and guidelines for the most common teleophthalmology applications will be discussed.

MODALITIES

Telemedicine is mature, technology is no longer a barrier, connectivity is a reality in most geographies, and the benefits are proven and real. Telemedicine can be performed in a synchronous or real-time face-to-face interaction with video technology or more simply with asynchronous store-and-forward technology, which does not require the patient and provider to be present ...