Abstract
Purpose :
To describe results of the United States Army Ocular Teleconsultation program from 2004 through 2018 and the current condition, benefits, barriers, and future opportunities for teleophthalmology in the clinical settings and disease areas specific to the United States military.
Methods :
653 ocular teleconsultations were reviewed; 76 concerned general policy questions and were not further analyzed while 577 were examined in more depth. The main outcome measures included diagnostic category, evacuation recommendation status by the consultant, the association of the request with trauma, the presence of photographs or advanced imaging, and which specialties participated in answering a request. The secondary outcome measures included the month and year each consult was requested, the average and median response time of consultants annually, the country from which the request originated, the military status and branch of service of each military patient, and the nationality, age, and military status of foreign patients.
Results :
The average response time in 2018 was 2.27 hours compared to 9.73 hours in 2004. 60% of consults originated from Iraq and Afghanistan. U.S. Army personnel comprised the largest percentage of consults (38.6%). Non-military patients from the US accounted for 19% of consults. Non-U.S. patients including coalition forces, contractors, detainees, and non-combatants accounted for 14.4% of consults, of which 22% were children. Anterior segment consults accounted for 45.1% of all consults with corneal surface disease being the largest subset within this diagnostic category. Dermatology and neurology were the most commonly co-consulted specialties. Photographs accompanied 37.4% of consults, with the likelihood requesters included photographs being greatest in cases involving pediatric ophthalmology (77.8%) and oculoplastics (71.7%). Evacuation was recommended in 22.7% of overall cases and 41.1% of trauma cases.
Conclusions :
Army teleophthalmology has been an indispensable resource in supporting and advancing military medicine, helping to optimize ophthalmic care for American military personnel, beneficiaries, allied forces, and local nationals worldwide. A dedicated ophthalmic care and coordination system which utilizes new advances in teleconsultation technology could further enhance our capability to care for the ophthalmic needs of patients abroad, with opportunity for improving domestic care as well.
This is a 2021 ARVO Annual Meeting abstract.