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Thomas Kandl, Linda Huang, Ben Szirth, Albert Khouri; Telepresence with multimedia solutions during ophthalmology residency. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2315.
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© ARVO (1962-2015); The Authors (2016-present)
Telepresence allows remote access to patient images and data in real time (RT). The aim is to test the feasibility of a telepresence system utilizing multimedia solutions during resident evaluation of patient data.
Both stereoscopic (stereo) and monoscopic (mono) images obtained during community screenings were evaluated by resident (RES) and an attending (ATT) in RT using simultaneous purpose built telemedicine software (Second Opinion Telemedicine Solutions, Torrance, CA) and “video-calling” (via commercially available applications on handheld devices). Images were assigned unique identifiers, and transmitted securely via a file sharing protocol and were evaluated in RT. Images were viewed on a 1440x900 pixel, 32bit resolution monitor in a standardized fashion in a dark room using a Stereo-viewer. RES evaluation was performed first and recorded, followed by ATT. RES accuracy of diagnosis, vertical cup to disc ratio (VCD), and referral recommendation (score 1-3: ie <1m, 1-3m, >3m) were evaluated by ATT with feedback given RT. Means, SD, analysis of variance and intraclass correlation coefficient (ICC) were calculated.
Total of 35 images were included in the analysis. Mean time of transmission was 7.45 sec/image. Diagnosis and referral recommendation were possible on all images. 16 stereo optic nerve images were evaluated for VCD and presence of peripapillary atrophy (PPA), and splinter hemorrhages. All but two had PPA and none had splinter hemorrhages. Mean VCD by RES and ATT evaluation of stereo images and referral recommendations correlated significantly Table 1. Stereo and mono images of the macula and anterior segment were also evaluated in RT; pathology included wet and dry age-related macular degeneration, filtering blebs, and congenitall anomalies.
This novel telepresence system with multimedia solutions allowed the remote assessment and feedback on all images in RT for clinical and educational purposes during resident evaluation of patient data. Measured parameters showed a high degree of correlation between RES and ATT. Applications of telepresence in ophthalmology residency and during resident education deserve continued study.
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