[Feasibility study of tele-ophthalmology in a prison setting]

Access to specialty care in prisons is complex and difficult, particularly in ophthalmology. The main goal of this study was to set up an ophthalmology telemedicine service in prisons to improve visual screening.

This was a prospective, single-center, observational, descriptive study including all patients referred, present, or entering the men's penitentiary in Rennes. The ophthalmological examination was performed using the semi-automated devices, VX 650 and Eye Refract, by the medical and paramedical staff of the penitentiary, who were not qualified in ophthalmology. The primary endpoint was a composite feasibility criterion, allowing validation of the telemedicine encounter. It assessed a combination of interpretable intraocular pressure, fundus photography, slit-lamp examination and consistent visual acuity.

Ninety-six patients participated in the study, with a mean age of 41years. The primary endpoint was achieved for 78 telemedicine encounters (81.3%). Sixty-two encounters (64.6%) were validated without the need for an in-person consultation.

In our study, 34 patients (35.4%) required a second, in-person examination. This was mainly due to two criteria for requesting an in-person visit (iridocornealangle analysis and subjective refraction errors). Our ophthalmology telemedicine protocol might be improved by remote management by a qualified professional (ophthalmologist, orthoptist) in certain situations to reduce the number of patients requiring a follow-up consultation.