Kanagasingam Yogesan

International transmission of tele-ophthalmology images.

Tele-ophthalmic consultations were conducted between a hospital in East Java, Indonesia, and an ophthalmology centre in Perth, Western Australia. Twenty-two eyes of 14 subjects were screened for glaucoma using a hand-held fundus camera. Optic disc images comprised 267 x 234 pixels at 24 bit/pixel (187 kByte). The images were compressed and stored together with patient information on a laptop computer. The images were then transmitted to Perth using either a mobile phone or a satellite phone, taking 170 s or 240 s, respectively. Images were also compressed to five different compression levels before transmission. At a compression ratio of 1 : 5, the images were 36 kByte in size and took 29 s to transmit by mobile phone and 60 s by satellite phone. To measure the loss of quality, the root mean square error was calculated for each colour component, comparing the transmitted and original images. The coefficients of variation were 10% (green), 15% (blue) and 22% (red). The images received in Perth were considered to be of excellent quality and readily interpreted by ophthalmologists in terms of the likely presence of glaucoma.

A survey of the state of telemedicine in Western Australia

To provide a baseline for future planning we conducted a survey of the use of telemedicine in the state of Western Australia. A questionnaire was designed, validated and posted to all public and private health-care facilities in Western Australia (metropolitan hospitals, country hospitals and nursing posts). Of the 132 questionnaires sent out, 102 were returned (77% response rate). Seven of the responding hospitals (all public) were classified as mainly providers of telehealth services and 95 (both public and private) were mainly receivers. Of these 95 receivers of services, 58 facilities (61%) reported that they had access to videoconferencing for telehealth purposes. The most common purposes for which videoconferencing was used were reported to be education (76% of those using videoconferencing), wound care (55%) and psychiatry (53%). The most common store-and-forward application was tele-ECG, which was reported by more than half (54%) of respondents. Eighty-five percent of public health-care facilities reported the use of telehealth (either videoconferencing or store-and-forward) in comparison with 24% of those in the private sector. There was a tendency for facilities further away from Perth to be users of more telehealth services: the correlation between distance and the number of telehealth services received was significant (Spearmans rho = 0.54, P < 0.001). The survey showed that about 73% of responding health-care facilities in Western Australia were using telemedicine.

Tele-ophthalmology screening for retinal and anterior segment diseases.

A digital indirect ophthalmoscope (DIO) was developed and tested for use in tele-ophthalmology screening for posterior and anterior segment diseases. Using custom software, images from the DIO were digitized, compressed, stored and transmitted to a centralized eye clinic for interpretation. A total of 43 subjects were primarily screened for glaucoma using the DIO, a hand-held fundus camera and a stereo fundus camera. The photographic slides from the stereo fundus camera were used as gold standards. Images (390 × 300 pixels × 3 bits) were stored using a laptop computer together with patient information. Image quality received at the central eye clinic was good and showed adequate diagnostic information. An ophthalmologist estimated cup–disc ratios and graded the quality of the images. The sensitivity and specificity of each instrument was calculated. A high sensitivity and specificity was found when using the DIO, indicating that it could be used in tele-ophthalmic screenings. Further modifications are needed to make the instrument more user-friendly and to enable it to be used with undilated pupils, so that it can be easily operated by health-care personnel in remote areas. The camera can also be used to image gross external eye pathology.

MEDLINE Versus EMBASE and CINAHL for Telemedicine Searches

INTRODUCTIONnResearchers in the domain of telemedicine throughout the world tend to search multiple bibliographic databases to retrieve the highest possible number of publications when conducting review projects. Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) are three popular databases in the discipline of biomedicine that are used for conducting reviews. Access to the MEDLINE database is free and easy, whereas EMBASE and CINAHL are not free and sometimes not easy to access for researchers in small research centers.nnnOBJECTIVEnThis project sought to compare MEDLINE with EMBASE and CINAHL to estimate what proportion of potentially relevant publications would be missed when only MEDLINE is used in a review project, in comparison to when EMBASE and CINAHL are also used.nnnMETHODSnTwelve simple keywords relevant to 12 different telemedicine applications were searched using all three databases, and the results were compared.nnnRESULTSnAbout 9%-18% of potentially relevant articles would have been missed if MEDLINE had been the only database used.nnnCONCLUSIONSnIt is preferable if all three or more databases are used when conducting a review in telemedicine. Researchers from developing countries or small research institutions could rely on only MEDLINE, but they would loose 9%-18% of the potentially relevant publications. Searching MEDLINE alone is not ideal, but in a resource-constrained situation, it is definitely better than nothing.

Gaps in the systematic reviews of the telemedicine field

The number of peer-reviewed publications in the telemedicine field has risen over the last ten years. As the number of publications increases, it becomes difficult to obtain an understanding of the field as a whole. To date, systematic reviews and guidelines have concentrated on specific telemedicine applications. There is no overview of the current situation regarding systematic reviews of telemedicine. Such an overview could provide answers to questions such as:

A Literature Review of Teleophthalmology Projects from Around the Globe

Introduction: Teleophthalmology is the application of telecommunications technology to eye care at a distance. Although many papers have been published on this subject over the last decade, none of them has attempted to classify publications based on the types of eye problems they focus on or the other aspects of eye care they address, such as method of delivery.

Retinal Screening for Early Detection of Alzheimer’s Disease

Alzheimer’s disease (AD) is the most common form of dementia and is characterized clinically by a progressive decline in memory, learning and executive function and neuropathology by the presence of cerebral amyloid deposits (beta-amyloid ‘plaques’ and tau ‘tangles’). Despite a century of research, there is still no cure or conclusive pre-mortem diagnosis for the disease. A number of symptom-modifying drugs for AD have been developed, but their efficacy is minimal and short lived. AD cognitive symptoms arise only after extensive irreversible neural deterioration has occurred; hence, there is an urgent need to detect AD early, before the onset of cognitive symptoms. An accurate, early diagnostic test for AD would enable current and future treatments to be more effective, as well as contribute to the development of new treatments.

Advances in Teleophthalmology: Summarising Published Papers on Teleophthalmology Projects

Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology.1 It does this through either a store and forward method or real-time communication, and so enables doctors to attend to patients in remote areas.21 It has been of increasing interest to researchers in the field of telemedicine over the last decade. This may have been due to the significance and prevalence of eye diseases, as well as a lack of specialists interested in working in remote areas. A simple search for teleophthalmological research via the Medline database yielded hundreds of results with varying aims and objectives. There had been a significant increase in the research over the past decade, and this made summarising the papers challenging. Although the studies possessed diverse aims and objectives, most focused on a particular eye problem, such as DR, glaucoma, adnexal disease etc. For instance, some of the projects questioned the feasibility of a particular type of teleophthalmological system for the screening of DR. Others concentrated on issues of cost and patient satisfaction. Whatever their main aims, each article took one or more eye diseases as its central theme. The question of what eye problems had been of interest to date is important. Regardless of design or conclusions, each paper was proof of the field’s increasing relevance. But what were the strengths and weaknesses of the teleophthalmological publications in terms of focusing on different type of eye problems? In other words, having considered the wide variety of eye disease which can be consulted through a telemedicine system, which area have been more of interest for researchers? There were also other important questions. For example, the type of telemedicine used in teleophthalmological projects (pre-recorded or real-time) would have been of interest to eye care specialists. Finally, the general conclusions made by the studies were also very significant. Were they positive, thus encouraging others to pursue the study, research and development of teleophthalmology? This short report discusses the findings of a systematic literature review of published papers that have documented teleophthalmological projects and been indexed by major bibliographic databases. It will also attempt to classify them in order to answer the following questions: 1. What types of eye problems have been focused on?

Video Imaging Technology: A Novel Method for Diabetic Retinopathy Screening

Objective: To evaluate the efficacy of a new imaging technique using retinal video recording and compression for diabetic retinopathy (DR) screening