Real-Time Mobile Teleophthalmology for the Detection of Eye Disease in Minorities and Low Socioeconomics At-Risk Populations

Al-Aswad, Lama A.; Elgin, Cansu Yüksel; Patel, Vipul P.; Popplewell, Deborah; Gopal, Kalashree; Gong, Dan; Thomas, Zach; Joiner, Devon; Chu, Cha-Kai; Walters, Stephen; Ramachandran, Maya; Kapoor, Rahul; Rodríguez, Maribel Fernández; Alcantara-Castillo, Jennifer; Maestre, Gladys E.; Lee, Joseph H.; Moazami, Golnaz

doi:10.1097/apo.0000000000000416

Cited by 16 publications

(22 citation statements)

References 51 publications

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“…Our study is not the first to utilize remote image analysis. A pilot study in northern Manhattan, New York demonstrated a high prevalence of undiagnosed ocular pathology; however, our study differs in that screening images were collected by medical students, and we incorporated an on-site ophthalmologist to validate the accuracy of the telehealth recommendations [20]. The Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study utilized a primary care telehealth ophthalmologic screening, followed by eye examination for those who needed it [21].…”

Section: Discussionmentioning

confidence: 99%

Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers

Cheng¹,

Babij²,

Cabrera³

et al. 2022

Cureus

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Ophthalmologic care is inaccessible to many people due to a variety of factors, including the availability of providers, cost of equipment for ophthalmologic care, and transportation to clinics and appointments. Because many causes of blindness are both highly prevalent and preventable once identified, it is essential to address gaps in care for underserved populations. We developed a novel 3D-printed mobile retinal camera. In this study, we organized recurring student-run screening events around New York City that took place in community centers and churches, at which we utilized our device to take retinal images. Our screening events reached a diverse population of New Yorkers, disproportionately those with lower household income, many of whom had not had recent eye exams. To validate the device for use in telehealth ophthalmologic visits, we transmitted the images to a remote ophthalmologist for evaluation and compared the result with an on-site attending physician's dilated eye exam. The subjective assessment indicated that 97% of images captured with the mobile retinal camera were acceptable for telehealth analysis. Remote image assessment by achieved 92% sensitivity and 83% specificity in detecting optic disc cupping, compared to the gold-standard on-site dilated eye exam. In addition, the device was portable, affordable, and able to be used by those with relatively little ophthalmologic training. We have demonstrated the utility of this affordable mobile retinal camera for telehealth ophthalmologic evaluation during community screening events that reached an underserved population to detect disease and connect with long-term care.

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Section: Discussionmentioning

confidence: 99%

Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers

Cheng¹,

Babij²,

Cabrera³

et al. 2022

Cureus

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“…1 Preclusion of the use of important diagnostic tools reduced follow-up for disease monitoring, and a substantial reduction in the performance of glaucoma surgery occurred. 8 US counties with high-poverty indices were disproportionately influenced by less utilization of telehealth services. 1 Importantly, these studies also directly comment on an expected ophthalmologic challenge of delayed patient care secondary to the pandemic for ophthalmic diseases, including retinal disease and glaucoma.…”

mentioning

confidence: 99%

“…Specifically, Medicare Advantage beneficiaries residing in rural isolated, small rural, and large rural areas utilized telemedicine visits significantly less than beneficiaries residing in urban areas (adjusted incidence rate ratio: 0.822, 0.754, 0.711, all P < 0.05) 1 . Preclusion of the use of important diagnostic tools reduced follow-up for disease monitoring, and a substantial reduction in the performance of glaucoma surgery occurred 8 . US counties with high-poverty indices were disproportionately influenced by less utilization of telehealth services 1 .…”

mentioning

confidence: 99%

Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists

Hussain,

Andoh,

Loya

et al. 2023

Journal of Glaucoma

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Précis: The change in glaucoma surgical volumes due to the COVID-19 pandemic was not uniform across procedure types and unequal between rural and urban practice locations. Purpose: To quantify the impact of the COVID-19 pandemic on surgical volumes performed by fellowship-trained glaucoma subspecialists. Methods: This retrospective cohort analysis of the CMS Medicare Public Use File extracted all glaucoma surgeries including micro-invasive glaucoma surgeries, trabeculectomy, goniotomy, lasers, and cataract surgery performed by fellowship-trained glaucoma surgeons in rural and urban areas between 2016 and 2020. Predicted estimates of 2020 surgical volumes were created utilizing linear squares regression. Percent change between predicted and observed 2020 surgical volume estimates was analyzed. Statistical significance was achieved at P<0.05. Results: In 2020, fellowship trained glaucoma surgeons operated mostly in urban areas (N=810, 95%). A 29% and 31% decrease in predicted cataract surgery volumes in urban and rural areas was observed. Glaucoma surgeries experienced a 36% decrease from predicted estimates (N=56,781). MIGS experienced a 86% and 75% decrease in rural and urban areas respectively. Trabeculectomy in rural areas experienced a 16% increase relative to predicted estimates while urban areas experienced a decrease of 3% (P>0.05). The number of goniotomies decreased by 10% more in rural areas than in urban areas (−22% and −12%, respectively). Laser procedures decreased by 8% more in urban areas than in rural areas (−18% and −10%, respectively). Conclusions: Among glaucoma-trained surgeons, glaucoma surgeries experienced a greater volume loss than cataract surgeries. In urban US areas, relative reductions in MIGS and goniotomy volumes in urban areas may have been compensated by greater laser and trabeculectomy volumes. Trabeculectomies in rural areas was the only group exceeding predicted estimates. Glaucoma subspecialists may utilize these findings when planning for future events and in overcoming any remaining unmet need in terms of glaucoma care.

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“…In addition, mobile health units are readily accessible, and some have already been launched in New York City (NYC), specifically real-time mobile teleophthalmology for the detection of eye disease in minorities and low socioeconomic at-risk populations. In this recent launch, 900 individuals were screened in high-risk communities in NYC between 2017 and 2018 and 48% were referred for ophthalmic evaluation 3…”

mentioning

confidence: 99%

“…In this recent launch, 900 individuals were screened in high-risk communities in NYC between 2017 and 2018 and 48% were referred for ophthalmic evaluation. 3 Another way of dealing with increasing disease burden is home monitoring, kiosks, or remote monitoring centers. The devices available for in-home monitoring are numerous, some of which are implantable, such as intraocular pressure sensors (eg, EyeMate device), and some rely on the operator, such as tonometers for intraocular pressure measurements at home, and virtual reality visual field devices.…”

mentioning

confidence: 99%

Transformation of Eye Care Through Innovations

Al-Aswad

Rakitina

2023

Asia-Pacific Journal of Ophthalmology

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I s change good? Regardless of where on the spectrum 1 might fall in answering this question, 1 thing is for sure, change is inevitable. But when it comes to health care, change is usually perceived as threatening and any effort to alter the status quo is being scrutinized relentlessly.What are the dominant factors driving change in health care now? First, health care expenditure, which is projected to increase to 5.7% from 4.8% in 2019 and reach nearly $6.0 trillion by 2027. While the nominal US Gross Domestic Product (GDP) growth is expected to average 4.6% during this period, health care spend as a percent of GDP is expected to increase to 19.4% by 2027, up from 17.8% in 2019. 1 Second, physician shortage is expected to reach 5400 by 2026. Moreover, the US population is estimated to expand to 438 million by 2050 which will influence the overall burden of eye disease, currently projected to increase amongst all sectors of the population over the next 20 or more years with cataract accounting for 45.6 million, diabetic retinopathy (DR) 13.1 million, glaucoma 5.5 million, and age-related macular degeneration 4.4 million. 2 Within the existing model of eye care, which can be best described as reactive, eye care providers position themselves on the sidelines, waiting for the patients to be referred to the ophthalmologist's office (Fig. 1A). Eye care providers get their patients through referrals from primary care colleagues, emergency departments, acute care hospitals, and long-term care facilities. However, patients residing in chronic care facilities are rarely referred to specialty ophthalmology services. Most of the referrals are made for already symptomatic patients. For instance, 2.7 million people in the United States have glaucoma but only 50% of them know about it. This means that over a million people with glaucoma will not get to the eye care specialist in time.A more efficient future model of care will be proactive in nature and will help reduce the burden of eye disease by integrating eye care providers through primary care practices, emergency departments, acute care hospitals, and long-term care facilities, with diagnostics, therapeutics, and preventative services available on site (Fig. 1B). This will lead to improved access to care and early capture of asymptomatic patients, thus leading to early detection of the disease on the population level and decreasing the burden of eye disease broadly.It may be inferred from this model that higher number of patients would be identified with a percentage of false-positive results. Consequently, the need for more eye care specialists would be required to match the demand for their services. To address this care gap, we need to utilize technologies, such as telemedicine, centralized reading centers with large databases that utilize a combination of eye care providers and artificial intelligence (AI). This would allow underserved populations and people living in chronic care facilities to be captured through telehealth visits. This would reduce disparities betw...

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Real-Time Mobile Teleophthalmology for the Detection of Eye Disease in Minorities and Low Socioeconomics At-Risk Populations

Cited by 16 publications

References 51 publications

Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers

Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers

Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists

Transformation of Eye Care Through Innovations

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