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A recently published review article in Clinical Ophthalmology[[1]] has foresighted teleophthalmology to play a critical role in ophthalmology management. However, teleophthalmology services in New Zealand are limited. Community medical centres and rural healthcare can be revolutionised with teleophthalmology. Generalists, equipped with a smartphone-based ophthalmoscope and fundus camera alongside an attached smartphone, and housing the proposed portal and internet connectivity, have found this is sufficient to field live ophthalmology consults.

The article[[1]] provides a sound framework that remarks on an array of ophthalmic clinical categories, where teleophthalmology and artificial intelligence technology have active roles in serving through screening, diagnosing or providing monitoring services. Teleophthalmology has already proven valuable for the following ophthalmic clinical categories: school screening, general eye care, emergency eye care, amblyopia, glaucoma, age-related macular degeneration, diabetic retinopathy, non-diabetic retinal eye disease, oculoplastics, strabismus, and cataracts and retinopathy of prematurity.[[1]] The published extensive literature review[[1]] analyses past, present and potential usage of teleophthalmology. Financial cost and a lack of acceptance and awareness for technology are factors underlying why teleophthalmology has not yet been widely implemented.

Recently, an innovative eye care research organisation from New Zealand, oDocs Eye Care, televised New Zealand’s first-of-its-kind teleophthalmology infrastructure on 6 May 2021 on national media platforms within New Zealand. The teleophthalmology exhibition had an ophthalmology specialist in an Auckland city office space, using a Samsung S7 tablet with access to 5G internet (Figure 2). The Auckland ophthalmology specialist fielded consecutive live consults with Dunedin ophthalmology specialists (Figure 1). The Dunedin ophthalmology specialists had access to a smartphone-based ophthalmoscope and fundus camera (nun ophthalmoscope and nun IR camera), attached to a smartphone with internet connectivity.[[2]] The devices used for the trial have been reviewed elsewhere[[3–5]] and their effectiveness have been studied and reported.

Systematically, three patients were examined after pharmacological pupillary dilation. Live consults were initiated by the doctors at Dunedin Hospital and consult requests were placed in the Auckland ophthalmology specialists’ teleophthalmology portal account waiting list. Patient histories were sequentially discussed while an examination was conducted. While, only retinal examinations were conducted, live consults are also effective for evaluating anterior ocular structures.[[6]] The teleophthalmology concept was successfully showcased, the targeted audience of general practitioners and optometrists were provided with a practical demonstration.

Recently, the demand for teleophthalmology services has increased, largely attributable to the global COVID-19 pandemic where face-to-face consultations were avoided when practical. Geographical barriers have contributed toward healthcare access inequities. While the efficacy of teleophthalmology is still being established, we do hypothesise a reduction in such inequities by implementing a teleophthalmology infrastructure in New Zealand. Other studies would suggest telehealth can achieve a reduction in morbidity through improved quality of healthcare, and educational opportunities and a reduction in costs, time and carbon footprint expended while travelling.[[7–10]]

The exhibition hosted by oDocs Eye Care was objective proof for the teleophthalmology concept. The exhibition successfully demonstrated how access barriers such as geographical separation and access to a specialist could be overcome; furthermore, there are salvaged opportunity costs in the form of time and travel expenditure. Further research is needed to establish the cost effectiveness, efficacy and usability of teleophthalmology. There are plenty of opportunities for teleophthalmology infrastructures to be implement within New Zealand, and ultimately, we can improve the ophthalmic care received by the New Zealand public.

Figure 1: A teleophthalmology live consultation using nun ophthalmoscope at Dunedin, New Zealand.

Figure 2: The view from the specialist side in Auckland.[[2]]

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Christopher Robert Giles Arthur: Nelson Hospital, New Zealand. Renoh Chalakkal: oDocs Eye Care, New Zealand; The University of Auckland, New Zealand. Ben O’Keeffe: oDocs Eye Care, New Zealand.

Acknowledgements

Correspondence

Christopher R G Arthur: Nelson Hospital, New Zealand.

Correspondence Email

chris.arthur8@gmail.com

Competing Interests

Nil.

1) Walsh L, Hong SC, Chalakkal RJ, Ogbuehi KC. A Systematic Review of Current Teleophthalmology Services in New Zealand Compared to the Four Comparable Countries of the United Kingdom, Australia, United States of America (USA) and Canada. Clinical Ophthalmology. 2021;15:4015-4027. doi:10.2147/OPTH.S294428

2) MedicMind Tele-ophthalmology Portal - YouTube. Accessed October 18, 2021. https://www.youtube.com/watch?v=0ArlgC4Zm8Q&t=12s&ab_channel=oDocsEyeCare

3) Singh A, Cheyne K, Wilson G, Jane Sime M, Chiong Hong S. On the use of a new monocular-indirect ophthalmoscope for retinal photography in a primary care setting. NZMJ. 2020;133:1512. Accessed April 1, 2021. www.nzma.org.nz/journal

4) Hafiz F, Chalakkal RJ, Hong SC, et al. A new approach to non-mydriatic portable fundus imaging. Expert Review of Medical Devices. 2022;19(4):303-314. doi:10.1080/17434440.2022.2070004

5) Shah D, Dewan L, Singh A, et al. Utility of a smartphone assisted direct ophthalmoscope camera for a general practitioner in screening of diabetic retinopathy at a primary health care center. Indian J Ophthalmol. 2021;69(11):3144-3148. doi:10.4103/IJO.IJO_1236_21

6) Teleophthalmology - medicmind. Accessed June 28, 2021. https://www.medicmind.tech/teleophthalmology

7) Moffatt JJ, Eley DS. The reported benefits of telehealth for rural Australians. Australian Health Review. 2010;34(3):276-281. doi:10.1071/AH09794

8) Jennett PA, Affleck Hall L, Hailey D, et al. The socio-economic impact of telehealth: A systematic review. Journal of Telemedicine and Telecare. 2003;9(6):311-320. doi:10.1258/135763303771005207

9) Tuckson R v., Edmunds M, Hodgkins ML. Telehealth. New England Journal of Medicine. 2017;377(16):1585-1592. doi:10.1056/NEJMsr1503323

10) Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242. doi:10.1136/bmjopen-2017-016242

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A recently published review article in Clinical Ophthalmology[[1]] has foresighted teleophthalmology to play a critical role in ophthalmology management. However, teleophthalmology services in New Zealand are limited. Community medical centres and rural healthcare can be revolutionised with teleophthalmology. Generalists, equipped with a smartphone-based ophthalmoscope and fundus camera alongside an attached smartphone, and housing the proposed portal and internet connectivity, have found this is sufficient to field live ophthalmology consults.

The article[[1]] provides a sound framework that remarks on an array of ophthalmic clinical categories, where teleophthalmology and artificial intelligence technology have active roles in serving through screening, diagnosing or providing monitoring services. Teleophthalmology has already proven valuable for the following ophthalmic clinical categories: school screening, general eye care, emergency eye care, amblyopia, glaucoma, age-related macular degeneration, diabetic retinopathy, non-diabetic retinal eye disease, oculoplastics, strabismus, and cataracts and retinopathy of prematurity.[[1]] The published extensive literature review[[1]] analyses past, present and potential usage of teleophthalmology. Financial cost and a lack of acceptance and awareness for technology are factors underlying why teleophthalmology has not yet been widely implemented.

Recently, an innovative eye care research organisation from New Zealand, oDocs Eye Care, televised New Zealand’s first-of-its-kind teleophthalmology infrastructure on 6 May 2021 on national media platforms within New Zealand. The teleophthalmology exhibition had an ophthalmology specialist in an Auckland city office space, using a Samsung S7 tablet with access to 5G internet (Figure 2). The Auckland ophthalmology specialist fielded consecutive live consults with Dunedin ophthalmology specialists (Figure 1). The Dunedin ophthalmology specialists had access to a smartphone-based ophthalmoscope and fundus camera (nun ophthalmoscope and nun IR camera), attached to a smartphone with internet connectivity.[[2]] The devices used for the trial have been reviewed elsewhere[[3–5]] and their effectiveness have been studied and reported.

Systematically, three patients were examined after pharmacological pupillary dilation. Live consults were initiated by the doctors at Dunedin Hospital and consult requests were placed in the Auckland ophthalmology specialists’ teleophthalmology portal account waiting list. Patient histories were sequentially discussed while an examination was conducted. While, only retinal examinations were conducted, live consults are also effective for evaluating anterior ocular structures.[[6]] The teleophthalmology concept was successfully showcased, the targeted audience of general practitioners and optometrists were provided with a practical demonstration.

Recently, the demand for teleophthalmology services has increased, largely attributable to the global COVID-19 pandemic where face-to-face consultations were avoided when practical. Geographical barriers have contributed toward healthcare access inequities. While the efficacy of teleophthalmology is still being established, we do hypothesise a reduction in such inequities by implementing a teleophthalmology infrastructure in New Zealand. Other studies would suggest telehealth can achieve a reduction in morbidity through improved quality of healthcare, and educational opportunities and a reduction in costs, time and carbon footprint expended while travelling.[[7–10]]

The exhibition hosted by oDocs Eye Care was objective proof for the teleophthalmology concept. The exhibition successfully demonstrated how access barriers such as geographical separation and access to a specialist could be overcome; furthermore, there are salvaged opportunity costs in the form of time and travel expenditure. Further research is needed to establish the cost effectiveness, efficacy and usability of teleophthalmology. There are plenty of opportunities for teleophthalmology infrastructures to be implement within New Zealand, and ultimately, we can improve the ophthalmic care received by the New Zealand public.

Figure 1: A teleophthalmology live consultation using nun ophthalmoscope at Dunedin, New Zealand.

Figure 2: The view from the specialist side in Auckland.[[2]]

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Christopher Robert Giles Arthur: Nelson Hospital, New Zealand. Renoh Chalakkal: oDocs Eye Care, New Zealand; The University of Auckland, New Zealand. Ben O’Keeffe: oDocs Eye Care, New Zealand.

Acknowledgements

Correspondence

Christopher R G Arthur: Nelson Hospital, New Zealand.

Correspondence Email

chris.arthur8@gmail.com

Competing Interests

Nil.

1) Walsh L, Hong SC, Chalakkal RJ, Ogbuehi KC. A Systematic Review of Current Teleophthalmology Services in New Zealand Compared to the Four Comparable Countries of the United Kingdom, Australia, United States of America (USA) and Canada. Clinical Ophthalmology. 2021;15:4015-4027. doi:10.2147/OPTH.S294428

2) MedicMind Tele-ophthalmology Portal - YouTube. Accessed October 18, 2021. https://www.youtube.com/watch?v=0ArlgC4Zm8Q&t=12s&ab_channel=oDocsEyeCare

3) Singh A, Cheyne K, Wilson G, Jane Sime M, Chiong Hong S. On the use of a new monocular-indirect ophthalmoscope for retinal photography in a primary care setting. NZMJ. 2020;133:1512. Accessed April 1, 2021. www.nzma.org.nz/journal

4) Hafiz F, Chalakkal RJ, Hong SC, et al. A new approach to non-mydriatic portable fundus imaging. Expert Review of Medical Devices. 2022;19(4):303-314. doi:10.1080/17434440.2022.2070004

5) Shah D, Dewan L, Singh A, et al. Utility of a smartphone assisted direct ophthalmoscope camera for a general practitioner in screening of diabetic retinopathy at a primary health care center. Indian J Ophthalmol. 2021;69(11):3144-3148. doi:10.4103/IJO.IJO_1236_21

6) Teleophthalmology - medicmind. Accessed June 28, 2021. https://www.medicmind.tech/teleophthalmology

7) Moffatt JJ, Eley DS. The reported benefits of telehealth for rural Australians. Australian Health Review. 2010;34(3):276-281. doi:10.1071/AH09794

8) Jennett PA, Affleck Hall L, Hailey D, et al. The socio-economic impact of telehealth: A systematic review. Journal of Telemedicine and Telecare. 2003;9(6):311-320. doi:10.1258/135763303771005207

9) Tuckson R v., Edmunds M, Hodgkins ML. Telehealth. New England Journal of Medicine. 2017;377(16):1585-1592. doi:10.1056/NEJMsr1503323

10) Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242. doi:10.1136/bmjopen-2017-016242

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A recently published review article in Clinical Ophthalmology[[1]] has foresighted teleophthalmology to play a critical role in ophthalmology management. However, teleophthalmology services in New Zealand are limited. Community medical centres and rural healthcare can be revolutionised with teleophthalmology. Generalists, equipped with a smartphone-based ophthalmoscope and fundus camera alongside an attached smartphone, and housing the proposed portal and internet connectivity, have found this is sufficient to field live ophthalmology consults.

The article[[1]] provides a sound framework that remarks on an array of ophthalmic clinical categories, where teleophthalmology and artificial intelligence technology have active roles in serving through screening, diagnosing or providing monitoring services. Teleophthalmology has already proven valuable for the following ophthalmic clinical categories: school screening, general eye care, emergency eye care, amblyopia, glaucoma, age-related macular degeneration, diabetic retinopathy, non-diabetic retinal eye disease, oculoplastics, strabismus, and cataracts and retinopathy of prematurity.[[1]] The published extensive literature review[[1]] analyses past, present and potential usage of teleophthalmology. Financial cost and a lack of acceptance and awareness for technology are factors underlying why teleophthalmology has not yet been widely implemented.

Recently, an innovative eye care research organisation from New Zealand, oDocs Eye Care, televised New Zealand’s first-of-its-kind teleophthalmology infrastructure on 6 May 2021 on national media platforms within New Zealand. The teleophthalmology exhibition had an ophthalmology specialist in an Auckland city office space, using a Samsung S7 tablet with access to 5G internet (Figure 2). The Auckland ophthalmology specialist fielded consecutive live consults with Dunedin ophthalmology specialists (Figure 1). The Dunedin ophthalmology specialists had access to a smartphone-based ophthalmoscope and fundus camera (nun ophthalmoscope and nun IR camera), attached to a smartphone with internet connectivity.[[2]] The devices used for the trial have been reviewed elsewhere[[3–5]] and their effectiveness have been studied and reported.

Systematically, three patients were examined after pharmacological pupillary dilation. Live consults were initiated by the doctors at Dunedin Hospital and consult requests were placed in the Auckland ophthalmology specialists’ teleophthalmology portal account waiting list. Patient histories were sequentially discussed while an examination was conducted. While, only retinal examinations were conducted, live consults are also effective for evaluating anterior ocular structures.[[6]] The teleophthalmology concept was successfully showcased, the targeted audience of general practitioners and optometrists were provided with a practical demonstration.

Recently, the demand for teleophthalmology services has increased, largely attributable to the global COVID-19 pandemic where face-to-face consultations were avoided when practical. Geographical barriers have contributed toward healthcare access inequities. While the efficacy of teleophthalmology is still being established, we do hypothesise a reduction in such inequities by implementing a teleophthalmology infrastructure in New Zealand. Other studies would suggest telehealth can achieve a reduction in morbidity through improved quality of healthcare, and educational opportunities and a reduction in costs, time and carbon footprint expended while travelling.[[7–10]]

The exhibition hosted by oDocs Eye Care was objective proof for the teleophthalmology concept. The exhibition successfully demonstrated how access barriers such as geographical separation and access to a specialist could be overcome; furthermore, there are salvaged opportunity costs in the form of time and travel expenditure. Further research is needed to establish the cost effectiveness, efficacy and usability of teleophthalmology. There are plenty of opportunities for teleophthalmology infrastructures to be implement within New Zealand, and ultimately, we can improve the ophthalmic care received by the New Zealand public.

Figure 1: A teleophthalmology live consultation using nun ophthalmoscope at Dunedin, New Zealand.

Figure 2: The view from the specialist side in Auckland.[[2]]

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Christopher Robert Giles Arthur: Nelson Hospital, New Zealand. Renoh Chalakkal: oDocs Eye Care, New Zealand; The University of Auckland, New Zealand. Ben O’Keeffe: oDocs Eye Care, New Zealand.

Acknowledgements

Correspondence

Christopher R G Arthur: Nelson Hospital, New Zealand.

Correspondence Email

chris.arthur8@gmail.com

Competing Interests

Nil.

1) Walsh L, Hong SC, Chalakkal RJ, Ogbuehi KC. A Systematic Review of Current Teleophthalmology Services in New Zealand Compared to the Four Comparable Countries of the United Kingdom, Australia, United States of America (USA) and Canada. Clinical Ophthalmology. 2021;15:4015-4027. doi:10.2147/OPTH.S294428

2) MedicMind Tele-ophthalmology Portal - YouTube. Accessed October 18, 2021. https://www.youtube.com/watch?v=0ArlgC4Zm8Q&t=12s&ab_channel=oDocsEyeCare

3) Singh A, Cheyne K, Wilson G, Jane Sime M, Chiong Hong S. On the use of a new monocular-indirect ophthalmoscope for retinal photography in a primary care setting. NZMJ. 2020;133:1512. Accessed April 1, 2021. www.nzma.org.nz/journal

4) Hafiz F, Chalakkal RJ, Hong SC, et al. A new approach to non-mydriatic portable fundus imaging. Expert Review of Medical Devices. 2022;19(4):303-314. doi:10.1080/17434440.2022.2070004

5) Shah D, Dewan L, Singh A, et al. Utility of a smartphone assisted direct ophthalmoscope camera for a general practitioner in screening of diabetic retinopathy at a primary health care center. Indian J Ophthalmol. 2021;69(11):3144-3148. doi:10.4103/IJO.IJO_1236_21

6) Teleophthalmology - medicmind. Accessed June 28, 2021. https://www.medicmind.tech/teleophthalmology

7) Moffatt JJ, Eley DS. The reported benefits of telehealth for rural Australians. Australian Health Review. 2010;34(3):276-281. doi:10.1071/AH09794

8) Jennett PA, Affleck Hall L, Hailey D, et al. The socio-economic impact of telehealth: A systematic review. Journal of Telemedicine and Telecare. 2003;9(6):311-320. doi:10.1258/135763303771005207

9) Tuckson R v., Edmunds M, Hodgkins ML. Telehealth. New England Journal of Medicine. 2017;377(16):1585-1592. doi:10.1056/NEJMsr1503323

10) Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242. doi:10.1136/bmjopen-2017-016242

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