April 2009
Volume 50, Issue 13
ARVO Annual Meeting Abstract  |   April 2009
Use of Telemedicine to Improve Access to Eye Care in a Remote Underserved Area
Author Affiliations & Notes
  • I. E. Zimmer-Galler
    Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
  • J. Handa
    Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
  • M. Wieland
    Retina-Vitreous Assoc, Inc., San Mateo, California
  • V. Yano
    Ministry of Health, Koror, Palau
  • K. Quinn
    Advanced Diagnostics, Inc., Boston, Massachusetts
  • R. Zeimer
    Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
  • Footnotes
    Commercial Relationships  I.E. Zimmer-Galler, EyeTel Imaging, Inc., C; Advanced Diagnostics, LLC, F; J. Handa, None; M. Wieland, None; V. Yano, None; K. Quinn, Advanced Diagnostics, LLC, C; R. Zeimer, Advanced Diagnostics, LLC, F; Advanced Diagnostics, LLC, P.
  • Footnotes
    Support  Supported in part by: NIH Grant R01 EY01753, NIH Core Grant R01 EY1765 (Bethesda. MD) ; Department research fund and Advanced Diagnostics, LLC
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 2500. doi:
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      I. E. Zimmer-Galler, J. Handa, M. Wieland, V. Yano, K. Quinn, R. Zeimer; Use of Telemedicine to Improve Access to Eye Care in a Remote Underserved Area. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2500.

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

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Purpose: : The Pacific island nation of Palau has a population of approximately 20,000. As a more western life-style is being adopted, the incidence of diabetes is rising at an alarming rate. Health care services are limited and there are no retina specialists in Palau to diagnose and treat the complications of diabetic retinopathy. The purpose of this study is to evaluate the implementation of a telemedicine diabetic retinopathy assessment sytem with remote image interpretation to assist in eye care delivery on this island nation.

Methods: : Two retina specialists (JH, MW) travel from the United States to Palau for several weeks each year to provide humanitarian eye care including laser and surgical treatment of retinal diseases. A telemedicine program has been implemented to assess patients remotely to identify those patients who will most benefit from intervention by the visiting retina specialists. The program utilizes an easy to operate automated fundus camera to image patients with diabetes. Images are obtained throughout the year by local health care providers. The images are reviewed at a reading center in the United States to identify patients requiring treatment. This allows optimal triage of patients in order that efforts can be focused on patients who will most benefit from intervention when the retina specialists return annually to Palau for several weeks.

Results: : The retinal camera was implemented in Palau in January 2007 and is being used to image patients with diabetes. To date, 74 patients have been imaged. Seventeen eyes of 9 patients were identified as requiring intervention (12 with diabetic macular edema, 3 with severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy, 1 with full thickness macular hole, 1 with branch retinal vein ccclusion). An additional 26 patients were noted to have mild to moderate nonproliferative diabetic retinopathy and will be re-imaged in one year. Images were unreadable for 16 patients. Twenty three patients had normal images with no abnormality noted in either eye.

Conclusions: : A telemedicine program has been successfully implemented on the isolated island nation of Palau. Patients requiring specialist care can be identified remotely to maximize the limited time of retinal specialists during their brief annual visit to Palau to provide eye care.

Keywords: diabetic retinopathy • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • clinical (human) or epidemiologic studies: risk factor assessment 

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