Performing Diagnosis Remotely – Telemedicine & Eye Care

Performing Diagnosis Remotely – Telemedicine & Eye Care

October 02, 2020

Everything changed with COVID-19. The use of telemedicine has boomed since the start of the COVID-19 pandemic.

Since in-person evaluations constrained to urgent and emergent visits because of COVID-19 and world-wide “shutdown, at the height of the pandemic, many doctors started relying on remote systems to safely screen and deliver patient care.

These days, eye care professionals are taking the opportunity to permanently expand their portfolio of telemedicine solutions.

Telemedicine’ or ‘Telehealth’ – Although both terms are used for the use of telecommunication technology providing traditional clinical services remotely; Current procedural terminology (CPT) more commonly uses the term “telemedicine”.

Telemedicine is performing the diagnosis and management of medical problems remotely using varied modalities.

Telemedicine describes health care delivery using various telecommunication technology techniques focused on providing traditional clinical services remotely.

Focused on accelerating the adoption of telehealth, the American Telemedicine Association (ATA) is in the spotlight as the coronavirus pandemic has overburdened health care providers and sent them quickly seeking telehealth solutions. Through its Special Interest Groups (SIGs), the ATA addresses specific areas of telehealthcare, and one of those areas is the field of eye care.

Telemedicine technologies are available in a variety of formats. These include synchronous, in which the patient and the practitioner are remotely communicating with each other in real-time, and asynchronous, in which diagnostic devices are used to examine a patient and the practitioner analyzes the resulting data later.

These remote tools include integrated telehealth and online services to keep practice operating both in-office and via virtual exam. Integrated telehealth allows us to easily document an exam on one tab while speaking directly with the patient via their phone or computer.

The telecommunication technology techniques used in telemedicine are;

  • Audio-video information that is transmitted in real-time (synchronous)
  • Stored and then forwarded audio and/or video information (asynchronous)
  • Social media applications such as WhatsApp, cell phone images (synchronous and asynchronous)

Official Definition – The American Academy of Ophthalmology (AAO) Task Force on Telemedicine in Ophthalmology defines asynchronous telemedicine as “electronic transmission of health care data (eg, images, text, or other digital data) to a provider for evaluation and service delivery using methods other than real-time interaction with the patient.”

These telemedicine technologies offer the practitioner a host of benefits for improving efficiency, safely seeing patients remotely, expanding care to remote patients, and accessing information from anywhere at any time. They can even enable the eye care professional to directly interact with the patient via remote video while simultaneously viewing the patient’s data on the computer.

Other benefits of specific technologies include allowing patients to track intraocular pressure at home with their device, detect and treat ocular misalignment, and diagnose specific eye conditions.

Doctors can more safely see patients, add exam capacity, extend practice hours and locations, and increase their productivity by conducting remote comprehensive digital eye exams. An in-office technician does a pretest while the rest of the exam is performed by a remote technician and the optometrist followed by a video conference to discuss the exam results and prescription. The optometrist can conduct the exam remotely.

From the beginning to the end of the patient experience, telemedicine in eye care leverages technology in the pursuit of efficiency. Optometrists can see patients themselves without face-to face-contact by conducting in-office comprehensive eye exams remotely from their home or adjacent office.

Telemedicine in Ophthalmology – Optometry

Especially the diabetic retinopathy (DR) and retinopathy of prematurity (ROP) are the two areas within Optometry that the use of telemedicine has developed significantly.

Other uses of telemedicine such as IOP monitoring, optic nerve analysis for macular disease detection, visual field analysis, and anterior segment diagnosis are currently in the progress. According to the latest news, the anterior segment diagnosis is expected to be in use of telemedicine shortly as well.

Based on the fact that online refractions do not have any information given to a health care provider, they are considered in telemedicine.

Telemedicine in Diabetic Retinopathy

The teleretinal programs are usually focused on to screen and detect for the presence of DR. In light of the high prevalence of diabetes and also screening equipment being relatively easy to use, the most popular use of telemedicine in eye care has become the “Teleretinal evaluation for DR.”

The teleretinal examination is a direct example of asynchronous telemedicine in eye care. In this practice, after the images are acquired they are evaluated digitally by an optometrist or ophthalmologist at a remote site. Therefore, the most common use of telemedicine in eye care has become the screening for common eye diseases.

In case retinopathy is detected at screenings, then the optometrist or ophthalmologist would recommend the patient to follow up with a dilated eye examination. As far as the good specific and sensitive results are concerned, this is known to be a proven modality.

Retinopathy of Prematurity

The rate of premature infants has increased in recent decades due to factors such as increased maternal age, assisted conception, and other socioeconomic issues. There is indeed high utilization of telemedicine related to the lack of trained specialists available to screen at-risk infants and to the increasing rate of ROP.

In light of trying to cover the shortage in this area, many clinics use teleretinal photography to screen for ROP. Indeed this is proven to be an accurate and cost-effective method to screen for this treatable eye disease.

The Future

The larger the volume data gets, the process becomes that much efficient. The efficiency is directly linked up with learning algorithms and adding data continuously.

Here again the AI – Artificial Intelligence steps in. Through using large datasets, an artificial intelligence program can train itself on how to recognize the signs of ocular conditions such as DR, age-related macular degeneration, ROP, and glaucoma.