Impact of combined live and cloud-based tele-ophthalmology system on referral patterns and disease identification at community eye centers in Nepal

Abstract

Background: The use of tele-ophthalmology service is rapidly increasing over the recent years. Currently Tilganga Institute of Ophthalmology (TIO) is using a number of tele-ophthalmology systems in its community eye centers (CECs), each with some challenges in terms of quality of pictures and human resources.

Methodology: To address these challenges, we propose to study the effects of a standardized, combined tele-ophthalmology system at two CECs: A structured protocol provided a simple algorithm for use of the various aspects of the tele-ophthalmology system. Live consultation was provided by fellows of vitreo-retina and cloud based consultation by the retina consultant. We assessed how this system changes utilization of tele-ophthalmology services, types of pathology detected using this system, rate of referral completion.

Results: The pre and post intervention observational type of study was conducted. A total of 600 patients were screened using the tele-consultation at post intervention. The mean age was 62.3 years with SD 13.0. Male and female comprised of 220 (36.7%) and 380 (63.3%). Diabetes mellitus and hypertension was found in 29.8% and 54.5% of the participants respectively. Blurring of vision was the major chief complains in both the eyes in nearly half of the study participants. Overall, 89% of the participants had some form of ocular problems. Anterior segment ocular problems comprised of 44.8% and posterior segment problems in 64.6%. After the tele-consultation, one fourth of the participants presented within the one month to three months for further evaluation at tertiary eye care center. In pre-intervention, a total of 380 participants were enrolled. Among these 203 (53.4%) were from the Nuwakot district CEC and 177 (46.6%) were from the Dhading district CEC. Out of the total cases, those needing referrals were 113 (46.89%) from Nuwakot and 128 (53.11%) were from the Dhading. Among the referral cases, those patients visiting TIO were 52 (46.85%) from the Nuwakot and 59 (53.15%) were from the Dhading within two years of follow up.

Conclusion: Tele-ophthalmology service has proved to be an effective method for detection, referrals and treatment of vision threatening cases to avoid the blindness. Combined both the live and cloud based tele-ophthalmology system could be effective modality to provide the eye care services in remote parts of Nepal and similar other settings.