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   Table of Contents      
EDITORIAL
Year : 2003  |  Volume : 51  |  Issue : 4  |  Page : 295-296

Tele-Ophthalmology in India. Is it here to stay?



Correspondence Address:
K R Kumar


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Source of Support: None, Conflict of Interest: None


PMID: 14750615

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How to cite this article:
Kumar K R, Yogesan K, Constable IJ. Tele-Ophthalmology in India. Is it here to stay?. Indian J Ophthalmol 2003;51:295-6

How to cite this URL:
Kumar K R, Yogesan K, Constable IJ. Tele-Ophthalmology in India. Is it here to stay?. Indian J Ophthalmol [serial online] 2003 [cited 2019 Oct 20];51:295-6. Available from: http://www.ijo.in/text.asp?2003/51/4/295/14658

Ophthalmology centres in India are pioneering some excellent work using information technology to promote eye care.[1],[2]

These are early days yet, but the scope and possibility of tele-ophthalmology can be optimised by changing our attitude towards the boundaries of tele-ophthalmology. For many people, tele-ophthalmology means the delivery of ophthalmic services, at a distance, using telecommunications. But, in practice, tele-ophthalmology covers all medical activities, including diagnosis, treatment, prevention, education and research. It makes the practice of ophthalmology independent of location or time. Tele-ophthalmology expands the range of ophthalmic services available to remote locations, but essentially, it must be understood as an integral part of ophthalmology, rather than a new tool.

At present, tele-ophthalmology already provides a real possibility for consultations either between general practitioners and ophthalmologists or between two or more ophthalmology units. Tele-ophthalmology in primary care appears reliable and is likely to be valuable in rural areas, where the distance to an ophthalmologist can be a significant obstacle to satisfactory diagnosis and treatment.[3] Tele-ophthalmology can support the use of real-time surgical telementoring to teach complex ophthalmology procedures.[4] It can provide secondary specialist advice in the diagnosis and treatment of ophthalmology cases.[5]

An Internet-based eye care system (www.e-icare.com) developed and evaluated at the Centre for e-Health at Lions Eye Institute, University of Western Australia uses images, videos, audio annotations and clinical and family history for teleconsultations. The center has developed a magnifying indirect ophthalmoscope,[6] digital handheld slitlamp imaging software, [7],[8],[9],[10] and telemedicine technology. [11],[12],[13],[14],[15],[16],[17],[18] These easy-to-operate devices can be connected directly to the online health care system to transmit multimedia information to specialists.

Tele-ophthalmology has been regarded as one way in which much-needed eye care services can be provided to everybody at a reasonable cost. But the cost-efficiency of tele-ophthalmology is not yet established. It has educational benefits and patients have been satisfied with the possibility of obtaining specialist care without having to travel. However, a large proportion of the financial savings associated with Tele-ophthalmology are not directly visible in the health care system. A significant economic impact may be made by savings in time and travel expenses, thereby indirectly contributing to society.

Currently several barriers inhibit the adoption of tele-ophthalmology in India. Among others, the list includes: affordability of programs, sustainability of programs, reimbursement for tele-ophthalmology consultations, regulations regarding sharing of information, privacy and security, and standards of technology.

Other organizational, financial and attitudinal barriers also exist. Tele-ophthalmology's future success and sustainability in India will depend upon the reliability of the technology and the speed of decision-making.

Tele-ophthalmology is expected to grow in the coming years in India, because:

Private health practitioners are embracing this currently public-dominated arena;

The equipment and transmission options are becoming economical and more widespread; and

Integrated Services Digital Networks (ISDN) are more widely available through local exchanges to community health centres and small hospitals, in locations where they were not previously available.

Finally, tele-ophthalmology needs a change of mindset. This involves proving the value of information technologies to clinicians in order to promote their use. It also involves sorting out the issues of access to data, confidentiality and privacy. An important part of attitude and mindset is education and training. When tele-ophthalmology initiatives are introduced, the users must be adequately trained.

If tele-ophthalmology is to flourish in India, it needs to be staged and nurtured. It needs to build on local skills and infrastructure, and based on local demand. There are many initiatives, and only a few will survive. The successful ones will be built around a sustainable competitive advantage.

The foundations for tele-ophthalmology are already in place in India. There is potential for explosive growth. To be sustainable, tele-ophthalmology has to build a competitive edge around relationship, cost, quality and time advantages.

 
  References Top

1.
Aravind Tele-Ophthalmology Network (ATN). http://www.aravind.org/current/telemedicine.htm. Accessed on 12 September 2003.  Back to cited text no. 1
    
2.
Tele-ophthalmology Clinic. http://www.sankaranethralaya.org/new.htm. Accessed on 12 September 2003.  Back to cited text no. 2
    
3.
Blomdahl S, Maren N & Lof R: Tele-ophthalmology for the treatment in primary care of disorders in the anterior part of the eye. J Telemed Telecare 2001;7:25-26.  Back to cited text no. 3
    
4.
Camara JG & Rodriguez RE: Real time telementoring in ophthalmology. Telemed J 1998;4:357-77.  Back to cited text no. 4
    
5.
Yogesan K, Constable IJ, MORGAN b, Soebadi DY. International transmission of tele-ophthalmology images, J Telemed Telecare 2000;5:41-44.  Back to cited text no. 5
    
6.
Cuypers MJ. Constable IJ. A new magnifying indirect stereo ophthalmoscope. Retina 1992;12:141-46.  Back to cited text no. 6
    
7.
Yogesan K. Constable IJ. Eikelboom RH. Van Saarloos PP. Tele-ophthalmic screening using digital imaging devices. ANZJ Ophthalmo 1998;26:9-11.  Back to cited text no. 7
    
8.
Eikelboom RH, Ylogesan K, Barry CJ, Constable IJ, Tay-Kearney M-L, Jitskaia L, House PH. Methods and limits of digital image compression of retinal images for telemedicine. IOVS 2000;41:1916-24.  Back to cited text no. 8
    
9.
Yogeasan K, Eikelboom RH, Barry CJ. Colour matching of serial retinal images, in vision science and its applications, OSA Technical Digest 1999;264-67.  Back to cited text no. 9
    
10.
Yogesan K, Barry CJ, JitzkaiaL, Eikelboom RH, van Saarloos, House PH, Morgan WH. Software for 3-D visualization/analysis of optic-disc images. IEEE Engineering in Biology and Medicine 1999;18:43-49.  Back to cited text no. 10
    
11.
Yogesan K, Henderson C, Barry CJ, Constable IJ. Online eye care in prisons in Western Australia. Journal of Telemedicine and Telecare (in press 2001).  Back to cited text no. 11
    
12.
Barry CJ, Henderson C, Yogesan K, Constable IJ. Wording towards a portable tele-ophthalmic system for use in maximum-security prisions: A pilot study. Telemedicine J and e-Health 2001;7:1-5.  Back to cited text no. 12
    
13.
Constable IJ, Yogesan K, Eikelboom RH, Barry CJ, Cuypers M. Digital screening for eye disease. Clinical and Experimental Ophthalmology 2000;28:129-32.  Back to cited text no. 13
    
14.
Yogesan K, Constable IJ, Barry CJ, Eikelboom RH, Morgan WH, Tay-kearney ML, Jitskaia L. Evaluation of a portable fundus camera for use in the tele-ophthalmologic diagnosis of glaucoma. J Glaucoma 1999;8:297-301.  Back to cited text no. 14
    
15.
Yogesan K, Barry CJ, Eikelboom RH, Constable IJ, Goltzsche H. Compression of Corneal Images for use in Telemedicine Systems. Advances in Medical Signal and Inforamtion Processing, IEE Conference Publication No. 476 , 2000. Institution of Electrical Engineers. pp.123-128.  Back to cited text no. 15
    
16.
Yogesan K, Cuypers M, Barry CJ, Constable IJ, Jitskaia. Tele-ophthalmology screening for retinal and anterior segment diseases, J Telemed Telecare 2000;5:96-98.  Back to cited text no. 16
    
17.
Yogesan K, Constable IJ, Barry CJ, Eikelboom RH, McAllister IL, Tay-kearney ML. Telemedicine screening of diabetic retinopathy using a hand-held fundus camera. Telemedicine Journal and e-Health 2000;6:231-35.  Back to cited text no. 17
    
18.
Barry CJ, Kanagasingam Y, Constable IJ, Eikelboom RH. A case for electronic manipulation of medical images? Journal of Audio- Visual Media in Medicine 1999;22:13-18.  Back to cited text no. 18
    



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