Telemedicine and tele-ophthalmology

Telemedicine is an exciting new tool that gives individuals in remote areas access to the same level of health care and up-to-date technology as the rest of the population. With elimination of the need to travel in order to receive medical treatment, the patient is much more likely to go to the doctor in the first place,1 and early detection, as we know, is crucial in many cases.

Quite simply, telemedicine is an exchange of medical information and health care over a distance. Its uses are many. Basically, telemedicine can be used in every aspect of medicine, from prevention, diagnosis and treatment to education1 and research, particularly in subspecialties such as ophthalmology, dermatology, pathology and radiology in which images are crucial for differential diagnosis.

As it pertains to ophthalmology, telemedicine has been used in different ways over the past few years. There have been several research projects in Europe involving real-time videoconferencing, visual electrodiagnosis, transmission of colour fundus photographs, and transmission of video clips, which permit assessment of eye position and mobility. This technology enables specialists from all over the world to assess a case while simultaneously discussing possible treatment plans. This is especially useful in cases of diagnostic ambiguity: several specialists worldwide can review images from diagnostic dilemmas in ophthalmology.

In 2001, Nieuwenhof and colleagues2 published data on the use of telemedicine as a diagnostic tool in ophthalmic pathology. The authors concluded that telemedicine is beneficial and reliable, particularly when the sender of the image is well trained in ophthalmic pathology.

In Canada, the Northwest Territories and Alberta are developing a tele-ophthalmology project that will use new technology to screen First Nations people with diabetes for early signs of retinal complications. The project will train technicians from the Stanton Regional Health Board in Yellowknife to conduct annual retinal screening tests with the use of a portable digital testing device. The technicians will visit remote communities on a rotating basis, conduct the tests and send the information to Alberta for diagnosis. Considering that 1 in 10 First Nations adults has diabetes that can lead to retinopathy and often blindness, this project will have a huge impact on the everyday life of not only the patients but also their families and the community as a whole.

Future challenges of telemedicine and tele-ophthalmology will include overcoming the natural resistance among many health care providers and patients to technologic changes as well as the present limitations of robot-assisted telesurgery.3 Ideally, the inevitable increase in the use of telemedicine will benefit a large number of patients despite their geographic, social and economic status.

Miguel N. Burnier, Jr., MD, PhD
Editor-in-Chief