Teleophthalmology through handheld mobile devices: a pilot study in rural Nepal

Area of Science:

• Ophthalmology
• Medical Technology
• Public Health

Background:

• Remote screening eye exams were conducted by ophthalmic technicians in Nepal.
• Digital photos of anterior and posterior segments were captured using a portable ophthalmic camera system attached to an iPod Touch.

Purpose of the Study:

• To compare referral recommendations from ophthalmic technicians with those of an ophthalmologist reviewing digital images.
• To evaluate the effectiveness of a mobile device-based teleophthalmology system for eye screening.

Main Methods:

• Ophthalmic technicians performed dilated screening eye exams and captured images.
• Images were uploaded to a secure cloud for remote review by an ophthalmologist.
• Referral decisions were compared between technicians and the remote ophthalmologist.

Main Results:

• The remote ophthalmologist recommended referral for an additional 20% of subjects not identified by technicians.
• The ophthalmologist agreed with 97% of technician referrals but identified missed posterior segment pathology.
• 34% of additionally identified subjects required retina clinic referral.

Conclusions:

• A mobile teleophthalmology system identified significant cases missed by on-site technicians, particularly posterior segment pathology.
• Handheld mobile devices show potential for effective teleophthalmic screening in resource-limited settings.
• This technology can improve access to eye care in remote areas.