Utilization and practical aspects of tele-ophthalmology between South Africa and the UK

Kennedy, Craig H.; Heerden, Anton Van; Cook, Colin; Murdoch, Ian

doi:10.1258/1357633011936895

Cited by 9 publications

(6 citation statements)

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“…Secondly, image transmission must be reliable. In a recent review of a teleophthalmology service established between Moorfields Eye Hospital and a regional hospital in South Africa, 17 there were few reported connection problems over a 1-year period. Thirdly, TM examination must be acceptable to patients.…”

Section: Clinical Signs In Trabeculectomized Eyesmentioning

confidence: 99%

Evaluating clinical signs in trabeculectomized eyes

Crowston

Kirwan

Wells

et al. 2004

Eye

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Aim To evaluate interobserver agreement for clinical signs in trabeculectomized eyes when examined face-to-face with slit-lamp biomicroscopy (SL) or by remote examination using telemedicine (real-time remote video imaging; TM). Method A system for examining trabeculectomized eyes was devised and validated. A prospective randomized interobserver agreement study was then undertaken to compare standard SL biomicroscopy and TM. Remote examination was performed using a 384 kbps Sony 5100 videoconferencing system. Three ophthalmologists each examined 40 eyes of 40 patients, who had previously undergone trabeculectomy. In rotation, two examiners used SL biomicroscopy. The third examined the eye remotely by TM. Analysis was performed to determine the variability in clinical signs and the presence or absence of systematic bias between ophthalmologists and examination methods. Results High levels of agreement were observed for paired examinations by SL biomicroscopy (SL/SL) for bleb vascularity (score range 0-10) with no systematic bias. Paired examination by SL and TM (SL/TM) also showed good levels of agreement for bleb vascularity, although the spread of disagreement was wider (95% limits of agreement 2.57 vs 2.98 (P ¼ 0.054)). For anterior chamber depth, observers agreed within 710% of anterior chamber depth for 68% of eyes (SL/SL) and 51% of eyes (SL/TM) (P ¼ 0.68). Agreement was 'good' for wall thickness (j ¼ 0.6370.08), bleb height (j ¼ 0.6770.1), and the existence of bleb leak (j ¼ 0.6370.19), but poor for bleb morphology (j ¼ 0.2670.12). For the SL/TM comparison, agreement was fair for wall thickness (j ¼ 0.3970.13), poor for bleb height (j ¼ 0.1770.12), good for bleb leak (j ¼ 0.5670.19), and fair for bleb morphology (j ¼ 0.3170.12). Microcysts were not reliably detected using either technique. Conclusion SL biomicroscopy and TM telemedicine examination may permit reliable clinical assessment of trabeculectomized eyes. However, remote examination with TM is more limited with respect to assessing bleb height and bleb wall thickness. The assessment of bleb morphology and microcysts was unreliable with both instruments. We propose that TM examination of trabeculectomized eyes appears safe and appropriate in situations where face-to-face examination by an ophthalmologist is not practical.

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Section: Clinical Signs In Trabeculectomized Eyesmentioning

confidence: 99%

Evaluating clinical signs in trabeculectomized eyes

Crowston

Kirwan

Wells

et al. 2004

Eye

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“…1 This new method of service delivery offers a number of substantial advantages over conventional face-to-face consultations. This includes cost effectiveness, 2,3 improved service accessibility in remote areas, 4,5 and local health-care workers gaining more experience in ophthalmology through participation in telemedical consultations. 1,4,6 There are several major components in a teleophthalmology system.…”

Section: Introductionmentioning

confidence: 99%

Telemedical diagnosis of anterior segment eye diseases: validation of digital slit-lamp still images

Kumar

Kanagasingam

Constable

2008

Eye

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Purpose This study compared digital images from a portable slit-lamp camera with 35 mm slit-lamp photographs and traditional ophthalmic assessments in anterior segment disorder's detection. Methods A total of 196 patients (392 eyes) were recruited from an anterior segment ophthalmology clinic. Each patient underwent an examination by an anterior segment ophthalmologist. Two to three standardized views of 640 Â 480 pixels digital images (portable digital slit-lamp camera) and 35 mm photographic slides (Zeiss slit-lamp camera) were taken after the examination. The same ophthalmologist reviewed these images in a masked fashion. Two other masked graders also assessed the digital images. The presence or absence of 33 specific findings was noted at each examination. Results Digital images showed moderate to excellent agreement to clinical findings (j 0.45-0.82) in areas other than lid pathologies. Lens findings from digital images had moderate to good agreement with the clinical gold standard (unweighted j 0.43-0.65, sensitivity 59-77%, specificity 86-94%). Gross cornea signs were well detected with digital images, (j 0.72-0.85, sensitivity 67-100%, specificity 98-99). More subtle corneal, conjunctival and lid abnormalities were not identified well. The statistical figures were very similar to the above-mentioned figures when the 35-mm film results were compared to clinical diagnoses. The two image formats showed better agreement when compared to each other than when either is compared with clinical findings. Conclusion Diagnoses using digital slit-lamp images were comparable to diagnosis using 35 mm photographic slides for some anterior segment abnormalities.

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“…In recent years, trials of telemedicine have been successfully performed within the USA regarding screening of diabetic retinopathy (DR)1 2 and retinopathy of prematurity 3 4. A limited number of reports exist regarding international use of telemedicine 5 – 7…”

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confidence: 99%

Ocular telemedicine between Nepal and the USA: prevalence of vitreoretinal disease in rural Nepal

Ulrich

Poudyal

Marks

et al. 2009

British Journal of Ophthalmology

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This study is aimed at reporting experiences with telemedicine between Nepal and the USA and at reporting the prevalence of age-related macular degeneration (AMD) and diabetic retinopathy (DR) in rural Nepal. AMD and DR are becoming more significant factors for non-reversible vision loss in rural Nepal due to increasing life expectancy and urbanisation. The prevalence of DM is low compared with the developed world, but the percentage of diabetics with DR is high, presumably due to limited access to healthcare. The higher prevalence of DM in Hetauda is explained as being due to a more urban lifestyle, dietary habits (more deep-fried food) and more advanced age.

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Utilization and practical aspects of tele-ophthalmology between South Africa and the UK

Cited by 9 publications

References 0 publications

Evaluating clinical signs in trabeculectomized eyes

Evaluating clinical signs in trabeculectomized eyes

Telemedical diagnosis of anterior segment eye diseases: validation of digital slit-lamp still images

Ocular telemedicine between Nepal and the USA: prevalence of vitreoretinal disease in rural Nepal

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