Use of telemedicine to assist ophthalmologists in developing countries for the diagnosis and management of four categories of ophthalmic pathology

Abstract

Introduction: The diagnosis and treatment plans proposed by ORBIS Telemedicine partners, all of whom were ophthalmologists, via Cyber-Sight, in four ophthalmic sub-specialty categories were compared to those suggested by expert mentors.

Methods: Records of referrals of patients via Cyber-Sight to mentors with a diagnosis of: glaucoma, pediatric cataract, external disease, and disorders related to the ocular adnexa requiring oculo-plastic treatment were reviewed. Records recalled from the Cyber-Sight electronic archives included: medical history, images of clinical findings, partner diagnosis, partner treatment plan, mentor diagnosis, and mentor treatment plan. Partners' diagnosis and treatment plans were compared to those of the mentors. Based on results of prior studies, mentor opinions were those considered valid (Helveston et al 2001).

Results: A total of 135 cases were reviewed: 70 external disease, 42 oculo-plastics, 16 glaucoma, and 7 pediatric cataract. The partner's diagnosis agreed with that of the mentor in: glaucoma 81%, pediatric cataract 86%, external disease 76%, and oculo-plastics 86%. Partners were considered to have suggested the correct treatment plan in: glaucoma 56%, pediatric cataract 71%, external disease 70%, and oculo-plastics 60%. Mentors provided additional comments and suggestions for further study in more than three-quarters of the cases.

Discussion: If one considers that the mentors are correct in each case, they offered a different diagnosis in 18% of cases. For treatment, mentors offered an alternate plan in more than a quarter of cases. The basis for considering the mentors being more accurate in diagnosis and treatment planning after viewing pictures and reading history than the partners who actually saw and examined the patients is based on personal experience of the authors. This includes a study done by one of them (EMH) demonstrating that experts when asked to view cases presented via telemedicine agreed nearly 100% on diagnosis and by a like amount on the method of treatment. In addition to this, results of this present study are similar to those for strabismus; a condition that was studied earlier (Helveston et al 2001). Still to be determined is whether this type of consultation changes outcome of treatment.

Figure 1

After logging on to http://www.cybersight.org and selecting “E-Consultation”, the unique user name and password are entered.

Figure 2

After logging in the partner chooses the sub-specialty, describes the case along with pictures and or images.

Figure 3

The partner gives a diagnosis and treatment plan.

Figure 4

Mentor response.

Figure 5

Post operative results and comments.