Canadian Journal of Ophthalmology

The official journal of the Canadian Ophthalmological Society
Volume 38, no.7, December 2003
  
Editorial
Telemedicine and tele-ophthalmology: part II

It is not a coincidence that my editorial in the August issue of the CJO was about the advantages and challenges of tele-ophthalmology.1 In that issue of the Journal I addressed the specific topic of diabetes mellitus and tele-ophthalmology. The importance of addressing the issue of quality long-distance ophthalmologic care for patients with diabetes is even more relevant when dealing with rural and aboriginal populations.

In my position as Editor-in-Chief of the CJO I cannot help but notice the increase in submissions regarding tele-ophthalmology, particularly as related to the early diagnosis of ocular complications in patients with diabetes. In this issue, three papers deal with this subject. Marie Carole Boucher and colleagues, in their paper "Effectiveness and safety of screening for diabetic retinopathy with two nonmydriatic digital images compared with the seven standard stereoscopic photographic fields" (see page 557), conclude that two-field nonmydriatic camera imaging is a safe screening strategy that may identify the patients with diabetes most in need of ophthalmologic care. Johanna Choremis and David R. Chow, in their report entitled "Use of telemedicine in screening for diabetic retinopathy" (see page 575), agree that tele-ophthalmology has an important role to play in the early diagnosis of diabetic retinopathy. They conclude that, despite the imperfections of such a system, their experience has been favourable, allowing them to screen large numbers of patients in a cost-effective, reliable manner.

As we all know, diabetes is now considered to be at epidemic proportions. It is estimated that 17 million people in the United States have the disease and that at least 16 million have prediabetes. The number of patients who receive the diagnosis every year is close to 1 million.2,3 This potentially devastating disease remains a leading cause of blindness in adults. Diabetic retinopathy is, in fact, the leading cause of new cases of blindness among North Americans aged 20 to 74 years. Fortunately, timely treatment can decrease rates of blindness and visual impairment by 90%.2 Using telemedicine as a screening tool for ocular complications has proven to be a highly efficient method to detect early signs of retinopathy.

In the United States the use of telemedicine in ophthalmology is growing by leaps and bounds. At the University of Maryland a new telemedicine program in ophthalmology allows ophthalmologists to "see" people at risk for diabetic retinopathy and glaucoma without the patients' having to leave their communities.4 By using an advanced retinal camera installed in various sites, including a shopping centre, ophthalmologists at the University are hoping to reach the portion of the population who do not visit an ophthalmologist regularly and may be at risk for diabetic retinopathy or glaucoma.

Clinical investigations evaluating the use of nonmydiatric cameras, as reported in the paper "Comparison of two, three and four 45 image fields obtained with the Topcon CRW6 nonmydriatic camera for screening for diabetic retinopathy," by Manuel Perrier and associates (see page 569), are extremely relevant in understanding the various options currently available.

I anticipate that our Journal will be publishing many more articles on the use of tele-ophthalmology, not only in the diagnosis of ocular complications of diabetes but also in other ocular conditions. The challenges mentioned in my previous editorial,1 including overcoming the natural resistance among many health care providers and patients to technologic changes as well as present limitations of robot-assisted telesur-gery, are still relevant.

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

References

1. Burnier MN Jr. Telemedicine and tele-ophthalmology [editorial]. Can J Ophthalmol 2003;38:343.
2. Goland R, Weinstock RS. Potential impacts of telemedicine on diabetes. In: Home telemedicine for the health care provider. A practical guide. Columbia University's Informatics for Diabetes Education and Telemedicine pro-ject. Available: http://www.ideatel.org/syllabus/impacts.html (accessed 2003 Nov 7).
3. Flowers CW Jr, Baker RS. The utility of telemedicine for diabetic retinopathy screening. Telemedicine and Telecommunications: Options for the New Century \ (symposium sponsored by the National Library of Medicine); 2001 Mar 13-14; Bethesda (MD). Available: http://collab.nlm.nih.gov/tutorialspublicationsandmaterials/telesymposiumcd/4A-3.pdf (accessed 2003 Nov 7).
4. Telemedicine program allows ophthalmologists to "see" people at risk for diabetic retinopathy and glaucoma [release]. University of Maryland Medical News 2003 July 31. Available: www.umm.edu/news/releases/eye_telemedicine.html (accessed 2003 Oct 24).