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Igor Kozak, John Payne, Patrik Schatz, Eman Al Kahtani, Moritz Winkler; Telemedicine image-based navigated retinal laser therapy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5853. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess feasibility of image transfer, registration and fundus fluorescein image-based distant planning and execution of retinal laser treatment between two clinics. Telemedicine-based approaches are becoming popular in lieu of increased medical care and the lack of specialists in some regions.
Patients underwent initial fundus imaging with Navilas (OD-OS GmbH, Germany) including fundus fluorescein angiography (FFA) at King Khaled Eye Specialist Hospital in Saudi Arabia (KKESH - clinic 1). FFA images were registered to the fundus image using Navilas Contact registration software and then transmitted in an encrypted format to collaborators at Palmetto Retina Center in Columbia, South Carolina, U.S.A. (clinic 2). Collaborators (retina specialists) created off-line treatment plans using Navilas Contact. The plans consisted of targeting microaneurysms and placement of computerized focal and grid patterns for navigated laser treatment. Plans were transmitted back to KKESH and laser treatment was performed on patients using Navilas laser photocoagulator.
Ten patients with diabetic macular edema entered the study. All treatment plans were successfully transmitted between two clinics without registration error. These served as templates for macular laser photocoagulation. Treatment site (clinic 1) did not make any modifications to treatment plans from clinic 2. Two eyes received pattern grid laser, four eyes focal laser only and four eyes combined focal/grid photocoagulation. All patients were successfully treated according to treatment plans (10) and all laser applications were placed according to plan (10/10). No adverse events occurred during photocoagulation.
This is the first study using telemedicine-based therapeutical rather than diagnostic approach. This pilot study demonstrates the feasibility and safety of using telemedicine to perform navigated retinal laser treatments regardless of geographical distance. As such it can have a broad application in both clinical practice and research where central reading (planning) center can standardize laser photocoagulation across all participating study sites, as previous studies have shown dramatic inter-operator variability in conventional laser photocoagulation.
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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