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Wolfgang Fink, Mark Tarbell; : A Smart Service Platform for Tele-Ophthalmology. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4110.
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© ARVO (1962-2015); The Authors (2016-present)
To provide ophthalmic healthcare to people who are geographically dispersed (e.g., rural populations), or operate/live in austere environments (e.g., military, third world, natural disaster), where time, cost, and possibility of travel make access to even adequate medical care difficult. As a result, significant causes of preventable vision loss, such as ocular trauma, glaucoma, and macular degeneration, may be detected early and treated in time to prevent permanent vision impairment.
Optical extension devices are attached to a smartphone to turn it into a mobile ophthalmic examination device. A custom app is engaged to perform an eye exam specific to the attached optical extension. Using a wireless connection, the smartphone app submits the collected examination data to a remote "expert system," which provides medical analysis. The analysis results are sent back to and displayed on the smartphone.
A server-based telediagnostic analysis capability for current and future smartphone-based ophthalmic examination devices has been developed. Examination data, gathered with such devices, can now be sent via WiFi or cell signal through a smartphone app to a server for automated analysis, the results of which are sent back to the originating smartphone almost immediately. As a first analysis example, the cup-to-disc ratio in fundus images is determined to assist the early detection of glaucoma. The fundus images are obtained via a commercial-off-the-shelf handheld ophthalmoscope that is attached to a smartphone. Moreover, a smartphone-based miniaturized pupillometer has been developed that allows for the recording of pupillary behavior in the presence and absence of light stimulation, i.e., pupillary light reflex and dark reaction. The pupillary diameter as a function of time is displayed in addition to parameters such as latency, constriction, and dilation times.
Smartphone-based mobile ophthalmic examination devices combined with server-based smart telediagnosis capabilities pave the way towards smart ophthalmics, i.e., smart tele-ophthalmology. This paradigm may greatly improve remote patient screening and triage. It may help ensure that patients with undiagnosed eye diseases are detected early and treated in time to prevent permanent vision impairment. Establishing this paradigm has the potential to change the very economy of extending quality healthcare to many while reducing cost.
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