Telemedicine in ophthalmology

Telemedicine may offer a viable means of relieving some of the pressure on overburdened national health systems by screening patients for degenerative retinal diseases such as diabetic retinopathy and age-related macular degeneration (AMD), according to a study presented at the 2012 EURETINA Innovation Awards. “As populations in western countries continue to live longer, the incidence of retinal degenerative diseases that can result in blindness is expected to increase in the coming years,†said Mario R Romano MD, PhD. Current screening methods are not adequate for this growing demand, but telemedicine in ophthalmology (TMO) might provide part of the solution,†he added. Dr Romano, Instituto Clinico Humanitas IRCSS, Milan, Italy, proposes an advanced telemedicine project that seeks to overcome some of the shortcomings of current screening methods. “At present screening for degenerative retinal diseases is mainly provided by dedicated referral centres where patient access is limited. The main problem is providing on-time access to guarantee prevention of disease and also adequate diagnosis to guarantee prompt care for the patient,†he said. Dr Romano added that screening efforts are currently hampered by the lack of connection between the remote units and the diagnostic units, as well as the dearth of structured databases. “Structured databases, which are the foundation of evidence-based medicine, are needed in order to make patient healthcare easier,†he said. Discussing the TMO solution in more detail, Dr Romano explained that it essentially involves the integration of technical and medical information. “The aim is to provide a technological platform for sharing patients’ data in order to improve diagnosis, collect epidemiological data and optimise access to resources. The 'core' of TMO includes five elements: remote diagnosis, telecare, e-learning, video telescreening, and finally cross doctor-hospitalphysician interaction,†he said. At the heart of the approach is an “expert system connectionâ€, a semi-automatic detection system that combines a vertical and horizontal intranet, said Dr Romano. “The vertical intranet is between patient and doctor, while the horizontal net is between medical staff and data managers. Combining them makes sense for faster and more efficient information sharing,†he said. For the vertical net component, peripheral data in the form of decentralised ophthalmological data and retinal image profiles are collected in remote units. The data is then sent to an automatic recognition system that is able to distinguish normal or pathological patterns based on its algorithm. The filtered information is then sent to specialised reading centres for recognition of the disease and periodic screening. While the proposed system is still in the development phase, Dr Romano believes that it has the potential to deliver a positive impact on the screening and diagnosis of retinal diseases. “With such an approach we could reduce diagnosis time, prevent diseases, foster continuous medical education via e-learning, share real-time information and reduce the costs of healthcare. We could also make a major contribution to data collection and evidence-based medicine,†he said. The horizontal net guarantees connection between the Reading Centers in order to help data-manager collecting clinical data, share real-time information (bad, waiting lists), he added. Potential users of the service would include hospitals and clinics that need to improve their screening services, as well as data managers in academic settings who need to access large amounts of data for publications, said Dr Romano. Ophthalmologists who prefer to work in team structures might also be interested in such an approach, he added.