Dr. Mukesh Taneja,
T06594, Mr. Sri Harsha, Mr. Ashutosh Richariya,
Dr. Rathi Varsha Madanlal
Authors:
Mukesh Taneja
Sri Harsha
Ashutosh Richhariya
Varsha Rathi
Affiliation:
L V Prasad Eye Institute
Hyderabad, India
Introduction:
According to WHO-2010 data, about 285 million people are visually impaired worldwide and 80% of this is preventable by timely detection and intervention. About 90% of the world’s visually impaired people live in developing countries.
While 70% of our population lives in rural India, 90% of the secondary and tertiary healthcare facilities are in urban areas, far away from rural population. With this project, we have intended to integrate the community care by taking eye care to rural populations in remote locations with tele-ophthalmic stereoscopic slit lamp biomicroscope with a real time interface between patients and ophthalmologists, thereby bridging the geographical and economic divide.
Tele-medicine :
With the development of computer and medical information technology, telemedicine is coming of age and is being increasingly used for providing healthcare services to individuals who are physically far from the healthcare provider. Telemedicine systems are essentially categorized into two different technical approaches:
- Offline store-and-forward systems that capture medical data and then forward them to doctors via e-mail or file; (generally this is the format which is being used currently, for diabetic screening, at some centers currently)
- Online systems that provide real-time consultation in terms of sampling medical data and consultation.
Telemedicine is increasingly being deployed all over the world, and is applied to quite varied medical sub-disciplines, such as home monitoring for the elderly, home monitoring for patients who have had recent surgery, cooperative consultation for complicated cases, emergency care for critically ill patients, screening for ailments and even healthcare in prisons.
It is quite evident that ophthalmology is ideal for telemedicine. Most eye pathologies are visible to inspection. While blindness is devastating, many eye diseases develop slowly. Thus, if the disease is detected early in its course and is appropriately treated, we can save many people from needless suffering from visual disability.
Purpose:
The purpose of this project is to integrate the community care by taking eye care to rural populations in remote locations with tele-ophthalmic stereoscopic slit lamp biomicroscope with a real time interface between patients and ophthalmologists, thereby bridging the geographical and economic divide.
Method :
The regular Slit lamps have been robotized with precision stepper and servo motors to motorize all the slit lamp functions. The slit lamp’s ocular lenses have been replaced with two CCD video cameras. The robotized slit-lamp can be operated from any remote location with an internet connected computing device. On-screen virtual controls give access to all the slit-lamp features such as magnification, X-Y-Z movement, slit controls and digital calipers. Real-time, 3-D stereoscopic viewing on any monitor is achieved with simple prismatic spectacles.
Three such systems were built, and were installed at one Tertiary care center, secondary care center and a primary care center of our hospital network
Results:
These three sites offered different ecosystem for operations in terms of available manpower, patient population and technological support for teleophthalmology. Patients have been regularly examined and cross consultations have been done between patients and ophthalmologists across the cities and villages with the teleophthalmic slit lamps. The overall experience of the patients and examiners with the teleophthalmic systems were very encouraging. The only one hindrance has been the fluctuations in internet connection bandwidth and latency, which caused difficulty to communicate occasionally.
Conclusion:
Successful testing of the teleophthalmic slit lamp demonstrated that it is feasible to use this technology to provide rapid and accurate three dimensional examination of the anterior segment of the eye, in patients with visual problems throughout rural regions of India. These automated teleophthalmic stereoscopic slit lamps helped the clinicians to do remote examinations at primary vision centre in rural areas, and cross consultation at secondary and tertiary centres.
Figure 1: User Interface on Desktop Figure 2: Tele-ophthalmic Slit Lamp Figure 3: Remote Practioner
References:
- Taneja Mukesh et al: Comparative functional evaluation of a stereoscopic robotized teleophthalmic drone slit lamp with conventional slit. ARVO-2014
- Tanabe et al : A Remote Operating Slit Lamp Microscope System – Development and its Utility in Ophthalmologic Examinations. Methods Inf Med 2011; 50: 427–434
- Zhuo Wei et al A Secure and Synthesis Tele-Ophthalmology System. Telemedicine and e-health 14 (8) • October 2008 833- 845