September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Implementing a Telemedicine Screening Program for Ophthalmic Disease at Bugando Medical Center in Mwanza, Tanzania
Author Affiliations & Notes
  • Peter Coombs
    Weill Cornell Ophthalmology, New York, New York, United States
  • Ceci Nicol
    Weill Cornell Ophthalmology, New York, New York, United States
  • James Shimba
    Weill Bugando Medical Center, Mwanza, Tanzania, United Republic of
  • Samwel Rweyemamu
    Weill Bugando Medical Center, Mwanza, Tanzania, United Republic of
  • Dennis Mutayabalwa
    Weill Bugando Medical Center, Mwanza, Tanzania, United Republic of
  • Rob Peck
    Weill Bugando Medical Center, Mwanza, Tanzania, United Republic of
  • Luke Smart
    Weill Bugando Medical Center, Mwanza, Tanzania, United Republic of
  • Robison Vernon Paul Chan
    Weill Cornell Ophthalmology, New York, New York, United States
  • Karyn Jonas
    Weill Cornell Ophthalmology, New York, New York, United States
  • Grace Sun
    Weill Cornell Ophthalmology, New York, New York, United States
  • Footnotes
    Commercial Relationships   Peter Coombs, None; Ceci Nicol, None; James Shimba, None; Samwel Rweyemamu, None; Dennis Mutayabalwa, None; Rob Peck, None; Luke Smart, None; Robison Chan, None; Karyn Jonas, None; Grace Sun, None
  • Footnotes
    Support  Research to Prevent Blindness
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1581. doi:
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      Peter Coombs, Ceci Nicol, James Shimba, Samwel Rweyemamu, Dennis Mutayabalwa, Rob Peck, Luke Smart, Robison Vernon Paul Chan, Karyn Jonas, Grace Sun; Implementing a Telemedicine Screening Program for Ophthalmic Disease at Bugando Medical Center in Mwanza, Tanzania. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1581.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Despite an increasing prevalence of diabetes (DM) and hypertension (HTN) in Tanzania, few patients are screened for retinopathy because of limited access to eye care. Teleophthalmology programs using non-mydriatic, digital fundus photography have been shown to effectively screen for retinopathy. A teleophthalmology screening program for patients with DM and HTN was implemented in Mwanza, Tanzania, to evaluate its efficacy and feasibility.

Methods : Patients with DM and HTN were recruited at Bugando Medical Centre (BMC). One to three 45 degree fundus photos were taken of each eye with a Topcon NW300 non-mydriatic fundus camera and IMAGEnet 5 software, V1.01 (Topcon Medical, Oakland, NJ). Using the store-and-forward telemedicine method, images were uploaded to a secure, web-based, HIPAA-compliant server, Amazon Cloud Drive (Amazon, Seattle, WA), and interpreted by 3 ophthalmologists at Weill Cornell Medical College in New York, NY. Interpreters assessed the media, optic nerve, vessels, macula, and periphery. Interpretations and recommendations were communicated to BMC with patient information deidentified via Google Forms (Google, Mountainview, CA), and then to the patients by phone. Two BMC medicine residents were trained in fundus photography and image upload to ensure sustainability.

Results : Three-hundred and nine original Joint Photographic Experts Group (JPEG) images (118 patients) were saved, stored, and forwarded. 58 patient images were interpreted in the pilot study (44 with HTN and 26 with DM). The average photo file size was 267 kB. Upload took 1-2 minutes per patient over wireless connection. Previously undiagnosed retinopathy was identified in 13/58 patients (22.4%), including dot blot hemorrhages (7 image sets), cotton wool spots (5), flame hemorrhages (4), exudates (3), intraretinal hemorrhages (3), white centered hemorrhage (3), papilledema (1). Five images showed multiple abnormalities. Optic nerve cupping, drusen, or pigment changes were identified in 12 images.

Conclusions : A teleophthalmology program using non-mydriatic, digital fundus images was implemented to diagnose retinal disease in an area of Tanzania with limited eye care. Medical personnel were trained in fundus photography and a web-based telemedicine system. This pilot study may guide others in initiating similar programs to screen patients in areas with limited access to ophthalmic care.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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