INTRODUCTION- American Telemedicine Association (ATA) says that
"telemedicine” is the natural progression of digital healthcare”.[1] World
Health Organization (WHO) has defined telemedicine as, “the delivery of
healthcare services, where distance is a critical factor, by all healthcare
professionals using information and communication technologies for the exchange
of valid information for the diagnosis, treatment and prevention of disease and
injuries, research and evaluation, and for the continuing education of
healthcare providers, all in the interests of advancing the health of
individuals and their communities.”[2] The word “telemedicine”
literally translates to ‘healing at a distance’. It often encompasses health
care delivery and also other activities such as education, research, health
surveillance, and public health promotion.[3]
ISRO (Indian Space Research Organization)
made a modest start in telemedicine in India with a telemedicine pilot project
in 2001, connecting Chennai 's Apollo Hospital with Apollo Rural Hospital in
the village of Aragonda in the Andhra Pradesh district of Chittoor [4].
In an effort to consolidate the
available public health data and provide easy access, the Government of India's
Ministry of Health has taken on projects like Integrated Disease Surveillance
Project (IDSP), National Cancer Network (ONCONET), National Rural Telemedicine
Network, National Medical College Network and the Digital Medical Library
Network [5]. Some notable examples of successfully developed Indian
telemedicine services include mammography services at Sri Ganga Ram Hospital,
Delhi; oncology at Regional cancer centre, Trivandrum [6] surgical
services at Sanjay Gandhi Postgraduate Institute of Medical Sciences, School of
Telemedicine and Biomedical Informatics, Medical College Network and the
Digital Medical Library Network.[7]
Teleophthalmology- Telemedicine
sector providing eye care through digital technology, medical equipment and
telecommunications devices. Today, applications of teleophthalmology enables
the eye specialists in examining patients in remote areas, ophthalmic disease
screening, diagnosis and monitoring; as well as distant learning.[8]
Visual images of the eye or retina for disease screening , diagnosis, treatment
, and control, are main parts in ophthalmology that can be done frequently via
digital imaging. With advancements in technology, resources and internet
ophthalmologists are adapting quickly to the changing technology using
telemedicine to improve patient access to medical care. Telemedicine has been
particularly effective in the diagnosis and monitoring of retinopathy of prematurity (ROP)
and diabetic retinopathy as shown in Fig. 1.
Fig.
1: Screening
of Diabetic retinopathy using teleophthalmology
A specialist health-care professional is
required to obtain a good fundus photograph, diagnose and treat the patient in
these cases. But minor ophthalmological problems can be solved just over the
phone by proper history taking and carefully understanding the problems of the
patient. This may reduce the unnecessary exposure of the patient and to the
doctor.
Internet is now the basic part and necessity
of life. One can easily send images or videos to any part of the world via the
internet. Where just history is not enough proper images of the eye of the
patient can be acquired through video consultation. It can also help in the
follow-up of the patient. Images can be saved and compared in each follow-up to
check the effect of drugs.
Most patients can be categorised into
sub-specialities (e.g. Anterior segment disease, Retina, Oculoplastic,
Paediatric ophthalmology etc.) based on their complaints and hence can be the
referred to respective specialist department. This will help in decreasing the
patient’s load on the doctor and providing proper care to the patient.
But all these require good resources,
good internet connection and some expertise in the digital field for better
communication. Also, the patient’s level of understanding and satisfaction
can’t be ignored.
Tele-ophthalmology
in rural India- As of 2011 census, India has 53 urban
agglomerations with a population of 1 million. Around 43 per cent of India's
urban population lives in these cities.[9] According to 2011 census,
68.84% of the total population leaves in Rural area. Most of these rural cities
have scarcity of resources. Electricity and good internet connections are major
concern in most of the parts. However, digitalisation is taking place at rapid
rate but still; most of the areas are still untouched.
In ophthalmology, which consists mostly
of geriatric patients, very few of them knowabout handling computers and
internet. According to 2011 census, the rural India literacy rate is 67.8%.
Adult literacy rate in rural India is 62.6% compared to 82.8% in the Urban
areas.[10]
Moreover, elderly patients being
unfamiliar with digital technologies find it hard to communicate their problems
and concern.[11] Until and unless a doctor sees them or investigate
them, they remain unsatisfied with the treatment being prescribed.
An ophthalmologist needs a better view
and close examination of the eye which is not possible even through video
conferencing. Slit-lamp examination is an inevitable procedure in almost all
the patients, which is again missed in telemedicine. Other basic
ophthalmological examinations such as tonometry, fundus examination is not
possible without a health care specialist.
Without a proper diagnosis, proper
treatment is impossible. In today’s time where ethical issues in the medical
field are continuously questioned ophthalmologists also refrain from
prescribing medications without proper investigations. There are many ethical concerns
in telemedicine which needs to be answered.
Also, the treatment protocol is quite
different in ophthalmology. There are drops, ointments, oral medications in
ophthalmology, so patients need to understand, what is being prescribed and how to use them.
One need to understand, which drop when to administer and how to administer.
CONCLUSIONS-
In the current situation of pandemic and panic in public, it can provide relief
to both patients and doctors. It can help majorly in preventing the patient to
get unnecessarily exposed in the hospital and thus decrease the hospital’s
load. In India, teleophthalmology has still a long way to go to establish it as
a boom. For now, it is a struggle in most parts. Lack of resources, unawareness
and the recognition by both the public and the practitioners of emerging
technologies are major factors, which are holding the telemedicine to reach its
potential.
Governments are now starting to take a
keen interest and major steps in developing resources to empower telemedicine
activities, resulting
in a slow but steady growth in its use in public health.
Hopefully telemedicine activities will achieve their true potential in a few
years ' time.
CONTRIBUTION OF AUTHORS
Research concept- Dr. Perwez Khan, Dr. Alok
Ranjan, Dr. Jayati Pandey
Research design- Dr. Alok Ranjan, Dr. Jayati Pandey
Supervision- Dr. Perwez Khan, Dr. Alok Ranjan
Materials- Dr. Ditsha Datta, Dr. Farhat Siddiqui, Dr. Dinesh
Kumar Yadav
Data collection- Dr. Ditsha Datta, Dr. Farhat Siddiqui, Dr. Dinesh
Kumar Yadav
Data analysis and Interpretation- Dr. Perwez Khan, Dr. Alok
Ranjan, Dr. Jayati Pandey
Literature search- Dr. Jayati Pandey, Dr.
Ditsha Datta, Dr. Farhat Siddiqui
Writing article- Dr. Jayati Pandey, Dr. Dinesh Kumar Yadav
Critical review- Dr. Perwez Khan, Dr. Alok Ranjan
Article editing- Dr. Perwez Khan, Dr. Alok Ranjan, Dr. Jayati Pandey
Final approval- Dr. Perwez Khan, Dr. Alok Ranjan
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