Catálogo de publicaciones - libros

Telemedical techniques in ophthalmology are currently being used in Spain. Our search shows that virtually all projects and settings are based on non-mydriatic cameras that obtain digital retinal images, which are then transmitted in store-and-forward mode to be examined by an ophthalmologist. The aim in most cases is to detect diabetic retinopathy in known diabetic patients. Despite the number of projects carried out on teleophthalmology in Spain, there are still too few published studies to reach general conclusions. However, we believe that teleophthalmology is a useful and feasible technique, at least for diabetic retinopathy screening. In Spain, as in many other countries, this disease fuels the implementation of teleophthalmology as a tool to manage ocular diseases. Unfortunately, although early treatment of diabetic retinopathy is of proven value in reversing or preventing visual loss, the infrastructure to detect appropriate patients for treatment is not yet universally available.

Delivering timely, cost-effective, quality care to beneficiaries and consultation partners is the goal of all health care systems. The particular challenges of distance, geography, and logistics faced by US Army ophthalmologists as they deliver this care attest to the ever-increasing relevance of telemedicine. Research and implementation of teleophthalmology solutions are providing opportunities to improve care, expand knowledge through training and distance learning, and provide services that were not possible a few short years before. Many of these applications, which are in use today, enable Army ophthalmologists both to assist other health care providers, and to deliver care directly to a geographically diverse beneficiary population. US Army ophthalmologists continue to develop and research new technologies in an effort to shorten the distance between the injured soldier or ill retiree and the ophthalmologist’s exam chair, thereby speeding interventions to preserve ocular health.

In this chapter we have (1) provided a state-of-the-art review on telemedicine applications in eye care with emphasis on emergency case management, (2) discussed the corresponding technologies, and (3) proposed an emergency teleophthalmology system, based on experience from other emergency telemedicine applications. The benefits of teleophthalmology for patients include (1) speed and accuracy of eye disease diagnosis, (2) avoidance of unnecessary transportation (and therefore low cost/high quality eye care services), and (3) efficient handling of emergency incidents. This is important for countries with dispersed populations in isolated areas (such as Greece, Sweden, Australia, etc.), where there are many regions where it is difficult to access medical services, and where there is unequal demographic distribution. Thus emergency teleophthalmology may be considered as an essential service. The requirements of an emergency teleophthalmology ystem, as discussed above, are mobility, user friendliness, minimum user technical involvement, and secure operation and reliability. However, it remains necessary for such systems to be tested by expert ophthalmologists and relevant medical personnel in order to assess not only user acceptance and satisfaction, but also the impact on the quality of the provided eye care services, along with health economics. Also of significant importance are issues related to organization of such services, training, and the legal and ethical issues linked to telemedicine applications. The fact, however, that emergency telemedicine has proved very successful in other health care areas is very promising for the ophthalmic care areas.