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Mariana de Andrade Coelho, Paulo H Morales, Solange Rios Salomao, Igor Rodrigo Lins da Silva, Mesquita Jardel, Mahler Giordani Mileo, Rubens Belfort, Jr., Luís Marcelo Aranha, Telemedicine in Amazon; Telemedicine as a useful tool for referrals to eye care services in a remote city of the Brazilian Amazon. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5882. doi: https://doi.org/.
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To determine the frequency of ocular diseases based on internet-transmitted images from patients of the city of Monte Negro, western Brazilian Amazon region.
A group of 427 consecutive patients (199 men) from a primary health care center aging 11 to 98 years were included from July-November 2013. After a 2-day training course for non-ophthalmologists physicians and medical students, 3 images of each eye were taken using a colored fundus camera (Icam®, Optovue, Inc). One picture of the anterior segment and two fundus pictures under pupil dilation (one centering the macula and the other centering the optic disc) were taken from each eye. The images were sent online to a reading center in the Federal University of Sao Paulo, analyzed by one ophthalmology resident and two experienced ophthalmologists. Cornea lesions (such as leukoma and pterygium) as well as cataract, optic disc cupping and retinal changes (eg scars, macular changes and vascular lesions) were evaluated. Feedback for diagnosis from the reading center was provided to help primary care personnel in their referrals for ophthalmic assessment.
Testability was high with only 20 (4%) patients with photos technically impossible to analyze. From the 407 (96%) analyzed patients, 243 (60%) were classified as normal eyes or minor ocular changes (hypertensive retinopathy, pterygium out of visual axis and suspicious of soft cataract). In the remaining patients classified as positive for ocular disorders (n=164), 145 patients were referred for cataract surgery (44%), 85 for glaucoma workup (25.9%), 39 for pterygium surgery (11.9%) and 16 (9.7%) for age-related macular degeneration for diagnostic confirmation and proper treatment at secondary and tertiary centers in the state capital.
In this underprivileged area of the Brazilian Amazon region, internet-transmitted ocular images helped the primary care personnel to prioritize the cases for secondary and tertiary ophthalmic care, avoiding unnecessary actions in places with difficult or no access to eye care. Further studies to evaluate sensitivity and specificity of the images as a screening tool are needed. Internet connectivity as well as cloud-based systems should be adequately implemented in these places to facilitate the remote diagnostic support. All these strategies might substantially reduce rates of blindness in the region.
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