Teleophthalmology for triage and management of corneal pathologies at vision centres: a prospective observational...

To assess the feasibility of teleophthalmology for triage and management of corneal diseases at vision centres (VCs) in rural and semi-urban North India.

All patients presenting to the VCs with corneal pathology who underwent teleconsultation for corneal disease during the study period (March-September 2024) were included in the study. Those who reported before or after the study period were not included. After registration and preliminary examination at the VC, unstained and stained images of patients with corneal pathologies were sent to an in-training cornea fellow at the tertiary centre via a web-based application. Management at the VC was carried out by vision technicians under specialist supervision; acute cases received preliminary emergency care and were referred to a secondary care hospital. Non-acute pathologies were managed at the primary level or referred as needed. Primary outcomes were the proportion of patients managed at VCs versus those referred, and compliance with referrals. Secondary outcomes were factors influencing referral compliance and reporting timelines for emergency and non-emergency cases.

Of 4, 825 patients with corneal disease, 2, 022 (41.91%) were managed at VCs, while 2, 803 (58.09%) were referred. Hot (acute/emergency) corneal cases comprised 1, 852; cold (non-acute/non-emergency) cases comprised 2, 973. Overall referral compliance was 27.58% (772/2, 803 referred cases). Regression analysis identified significant predictors of referral uptake, including proximity to hospitals and longer-established centres (p<0.001 for most associations). Acute cases and those from centres more than one year old were more likely to reach the hospital after referral.

Teleconsultation provided by specialist ophthalmologists enabled local triage and management of corneal diseases at the primary level, reduced unnecessary referrals, and helped counsel patients in emergency conditions. This model can be adopted by other ocular specialities and strengthen primary care in resource-constrained areas.