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S.M. Bar–Sela, Y. Glovinsky; Application of Internet– Based Tele–Consultation in Ophthalmic Emergency Room Practice . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1953.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the feasibility and practicality of video transmission of slit–lamp images using a low bandwidth internet–based telemedicine system. Methods: Participants included 49 complicated cases (98 eyes) encountered during evening and night shifts in ophthalmic emergency room (E.R). The resident in–charge consulted with a senior physician regarding each case using the telemedicine system. Images of the ocular adnexa and surface, anterior segment, anterior chamber angle and retina were taken by the resident in–charge using a slit–lamp connected to a video camera. Processed clips and still pictures were transmitted to a senior physician for consultation through an Asymmetric Digital Subscriber Line (ADSL) line with an upload and download capacities of 12.5 Kbytes per second and 200 Kbytes per second, respectively. A real–time regular telephone line was used for simultaneous audio communication. Each case was reexamined by a senior physician on the day after consultation in order to estimate the accuracy of the diagnosis made during the night. A feedback form was completed by the resident and the senior physician after each case. Main outcome measure included consultation time and physician's satisfaction regarding the system (graded from 1 to 5). Results: Processed clips and still pictures obtained through internet–based telemedicine system offered satisfactory visual resolution of ocular adnexa and surface (32 cases; mean score 4.5; range: 3.5–5), anterior segment (10 cases; mean score 4.4; range: 3.5–5), anterior chamber angle (5 cases; mean score 4.7; range: 4–5), optic nerve (2 cases; mean score 4.25; range: 4–4.5) and macular disorders (4 cases; mean score 4.25; range: 4–5). On the other hand, the system provided unsatisfactory images of the peripheral retina (8 cases; mean score 3.2; range: 2–4.5), which were subjected to lens artifacts. However, good quality images of peripheral retinal breaks and laser treatments could be obtained after short training. The whole consultation time was lengthened by an average of 5 minutes due to photography and transmission time. Conclusions: A low–bandwidth internet–based telemedicine system offers an easy and efficient operation by nonqualified residents, and provides sufficient information for resident–senior consultation regarding ocular adnexa and surface, anterior segment, anterior chamber angle, optic nerve and macular disorders.
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