Research Highlights Potential Benefits of Telemedicine in Treating Eye Disease

Nov 12, 2007, 00:00 ET from American Academy of Ophthalmology

    NEW ORLEANS, Nov. 12 /PRNewswire/ -- Two studies being presented at the
 American Academy of Ophthalmology's 2007 Annual Meeting suggest that
 telemedicine may have a significant role to play in the diagnosis of eye
 diseases, increased patient compliance and patient access to quality care.
     In the first study, researchers examined the impact that telemedicine
 had on patients with diabetes being treated in multi-physician primary care
 practice. The study looked at the number of patients with diabetes over the
 course of a year who had the recommended retinal examination before the
 installation of a telemedicine remote imaging system in the practice versus
 the number of patients with diabetes who had a retinal examination in the
 two years following installation of the device.
     "In the past, it has been shown that telemedicine is technically
 possible, but this study demonstrates the true impact of a telemedicine
 system on the number of patients with diabetes who end up having an
 evaluation for diabetic retinopathy," said Ingrid Zimmer-Galler, MD,
 assistant professor of ophthalmology at the Wilmer Eye Institute at the
 Johns Hopkins School of Medicine. "With this system, we've dramatically
 increased the rate of annual retinal evaluations."
     In the first year, out of 1,257 diabetic patients in the study, only 15
 percent had a retinal examination. Two years after implementation of the
 telemedicine system, 71 percent of the 1,395 diabetic patients in the
 practice had a retinal examination. Significantly, of the observed
 increase, 66 percent was due to an eye examination by a local
 ophthalmologist and only 33 percent was due to remote evaluation.
     "It's very nice to see that increased rate of evaluations was not
 solely because these patients were undergoing remote imaging," said Dr.
 Zimmer- Galler. "It shows that by having this type of system in place,
 overall awareness of the problem increased and had a beneficial affect on
 all patients."
     Increased awareness of the need for regular eye examinations by people
 with diabetics is important because of compliance issues among diabetics
 and the growing number of people with diabetes. Diabetic retinopathy
 affects an estimated 5.3 million people in the United States, as many as
 one-third of whom are unaware of their illness. People with diabetes are 25
 times more likely to go blind than people who do not have the disease.
 Early detection and treatment of diabetic retinopathy significantly
 increases the chances of avoiding vision loss.
     "There's been a tremendous push to raise diabetic retinopathy awareness
 and the need for regular eye examinations, but few other programs have
 demonstrated such a positive impact on overall rates of evaluation for
 diabetic retinopathy," said Dr. Zimmer-Galler.
     Offering Quality Care to Premature Infants
     In a second study presented at the annual meeting, researchers
 concluded that there was a high level of agreement between diagnoses of
 retinopathy of prematurity (ROP) made in low birth-weight babies using
 ophthalmoscopy and image-based telemedicine examinations.
     "The number of premature infants is increasing throughout the world,
 and a larger percentage of them are surviving," said Michael Chiang, MD,
 assistant professor of ophthalmology and biomedical informatics at the
 Columbia University College of Physicians and Surgeons and presenting
 author of the paper. "The challenge is how do we make good care accessible
 to these babies. The purpose of this study was to see how well the results
 of telemedicine compared to those of an ophthalmoscopic examination."
     Doctors at Columbia gathered data on 206 eyes from 67 prematurely born
 infants, performing up to two sets of examinations on each baby. In each
 instance, a pediatric ophthalmologist performed dilated indirect
 ophthalmoscopy on the infant to determine whether the baby had ROP.
 Diagnoses were classified in four categories: no ROP, mild ROP, type 2
 prethreshold ROP, and treatment-requiring ROP.
     Shortly after the physician's examination, a trained nurse captured
 retinal images of the same child using a wide-angle camera. A period of
 four to twelve months was allowed to elapse before images were shown to the
 same doctor who performed ophthalmoscopy, in order to minimize any chance
 that the examiner could remember details.
     In 86 percent of the eyes, there was complete agreement between the
 diagnoses made by ophthalmoscopy and telemedicine. Among eyes where there
 was disagreement between the examination modalities, 12 cases involved
 clinically- significant discrepancies regarding presence of zone I disease
 or plus disease. Dr. Chiang suggests that telemedicine diagnosis may be
 more accurate in these cases, because images can be compared directly with
 standard photographic definitions of zone I or plus disease.
     "Telemedicine exam may be more reproducible than if you see an infant's
 retina only briefly during ophthalmoscopy," he says. "There is a rationale
 that image-based examination may be better because findings are documented
 photographically. In many other ophthalmic diseases, definitions are based
 on standard images, so this has implications for the way we might deliver
 the best care to patients in the future."
     About the American Academy of Ophthalmology
     The American Academy of Ophthalmology is the world's largest
 association of eye physicians and surgeons-Eye M.D.s-with more than 27,000
 members worldwide. Eye health care is provided by the three "O's" -
 opticians, optometrists and ophthalmologists. It is the ophthalmologist, or
 Eye M.D., who can treat it all: eye diseases and injuries, and perform eye
 surgery. To find an Eye M.D. in your area, visit the Academy's Web site at

SOURCE American Academy of Ophthalmology