The United States Army Ocular Teleconsultation program 2004 through 2009

Mines, Michael J.; Bower, Kraig S.; Lappan, Charles M.; Mazzoli, Robert A.; Poropatich, Ronald K.

doi:10.1016/j.ajo.2011.01.028

Cited by 39 publications

(26 citation statements)

References 20 publications

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“…43,46,48,52,53 Portable anterior segment photography with mobile phone camera devices has been evaluated. 41,44 Barsam and colleagues provided a descriptive technique of anterior segment slit lamp photography with the iPhone. 45 Bhosai and colleagues found moderate reliability, but not always high accuracy, when using iPhone technology when compared to SLR photos for detecting clinically active trachoma.…”

Section: Discussionmentioning

confidence: 99%

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Woodward

Musch

Hood

et al. 2017

Cornea

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Purpose Corneal and anterior segment diseases cause the majority of urgent visits to eye-care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from two portable cameras for telemedicine purposes. Methods A prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A corneal 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 presence of pathology. Accuracy to detect disease was compared to gold standard diagnosis, stratified by 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 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 54–71% for iTouch and 66–75% for Nidek, across graders; specificity ranged from 82–96% for iTouch and 91–98% for Nidek. Inter-grader reliability was moderate to strong (kappa ranges: 0.54–0.71 for iTouch; 0.75–0.76 for Nidek. Quality ratings were variable between graders. Conclusions External photographs taken by standard, non-enhanced 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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Section: Discussionmentioning

confidence: 99%

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Woodward

Musch

Hood

et al. 2017

Cornea

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“…In 23.5% of 285 consultations over the review period, requesters specifically asked for guidance to determine need for medical evacuation. 5 This reflects a need for support by frontline providers and how the ophthalmology patient can be daunting for the “uninitiated.”…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

The Current State of Teleophthalmology in the United States

et al. 2017

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Telemedicine services facilitate the evaluation, diagnosis, and management of the remote patient. Telemedicine has rapidly flourished in the United States and has improved access to care, outcomes, and patient satisfaction. However, the use of telemedicine in ophthalmology is currently in its infancy and has yet to gain wide acceptance. Current models of telemedicine in ophthalmology are largely performed via “store and forward” methods, but remote monitoring and interactive modalities exist. Although studies have examined the effects of telemedicine, few reports have characterized its current status. We perform a descriptive analysis of the current state of teleophthalmology in the United States. We describe the use of teleophthalmology in the hospital and outpatient settings. We also review the applications to retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, and glaucoma, as well as anticipated barriers and hurdles for the future adoption of teleophthalmology. With ongoing advances in teleophthalmology, these models may provide earlier detection and more reliable monitoring of vision-threatening diseases.

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“…[18][19][20][21][22] It has also been cited as a teaching tool to educate general practitioners. 19,20 In the United States, teleophthalmology has been used by large health care system networks, such as Kaiser Permanente and the US military 23 and Veterans Affairs systems. For example, since 2005, Veterans Affairs hospitals have implemented teleretinal imaging, a store-and-forward mode of teleophthalmology that uses digital retina cameras and remote image interpretation 18,24 ; this program has been successful for accurate and sensitive diagnosis and referral.…”

mentioning

confidence: 99%

Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

2016

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IMPORTANCE Determining the perceived supply and potential demand for teleophthalmology in emergency departments could help mitigate coverage gaps in emergency ophthalmic care. OBJECTIVE To evaluate the perceived current need for and availability of ophthalmologist coverage in California emergency departments and the potential effect of telemedicine for ophthalmology triage and consultation. DESIGN, SETTING, AND PARTICIPANTS Surveys were remotely administered to 187 of the 254 emergency departments throughout California via the telephone and Internet from June 30 to September 23, 2014. Emergency department nurse managers and physicians from all emergency departments listed in the California Office of Statewide Health Planning and Development database were individually surveyed to assess facility characteristics and resources as well as the perceived usefulness of teleophthalmology consultation. Data analysis was conducted from June 30, 2014, to March 11, 2015. MAIN OUTCOMES AND MEASURES Perceived availability of ophthalmology consultation coverage and perceived effect of telemedicine ophthalmology consultation at each facility. RESULTS Of the 187 emergency departments surveyed, 18 of 37 rural facilities (48.6%) reported availability of emergency ophthalmology coverage, compared with 112 of 150 nonrural facilities (74.7%). Rural facilities reported a mean (SD) of 23.72 (14.15) miles between the facility and referral location, while nonrural facilities reported a mean of 4.41 (10.23) miles (19.3% difference). On a scale of 1 to 5 (where 1 signifies very low value and 5 signifies very high value), 124 of 187 nurse managers (66.3%) and 80 of 121 physicians (66.1%) rated teleophthalmology as having high or very high value for triage purposes. The most frequently cited potential advantage of emergency teleophthalmology was assistance in patient triage and immediate real-time electronic communication, and the most frequently cited potential disadvantages were unknown cost of contracting and maintenance and concern that eye trauma might make photographs or videos less conclusive. CONCLUSIONS AND RELEVANCE Availability of ophthalmology coverage for emergency eye care is limited, particularly among rural emergency departments in California. Surveyed emergency department nurse managers and physicians indicated moderately high interest and perceived value for a teleophthalmology solution for remote triage and consultation. Overall, the study suggests that teleophthalmology could play a role in mitigating coverage gaps in emergency ophthalmic care and could be further investigated through similar studies in other regions.

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The United States Army Ocular Teleconsultation program 2004 through 2009

Cited by 39 publications

References 20 publications

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

The Current State of Teleophthalmology in the United States

Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

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