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
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