Teleglaucoma to speed assessment
Royal Alexandria Hospital, Edmonton, uses teleglaucoma to speed patient assessment. The wait time to see a glaucoma specialist is four to six months, Dr. Damji said. Using technicians for an initial interview, history, exam, visual field, and imaging, then sending the file to a glaucoma specialist for grading and treatment recommendations reduces access time from a mean of 88 days to 45 days and screening time from 115 minutes to 78 minutes.
“The whole field of mobile health is taking off with a number of different models,” Dr. Damji said. “Machine learning would be enormously helpful, but this is a very exciting time.”
The biggest barriers to the adoption of teleglaucoma are regulatory and financial.
“Telemedicine is still the practice of medicine, bounded in case law and medical practice acts,” said Mark Horton, OD, MD, director of the Indian Health Services/Joslin Vision Network Tele-ophthalmology Program, Phoenix, AZ. “Standards of care for telemedicine are still evolving.”
Some state practice acts speak to telemedicine or special exemptions, but over half require full and unrestricted licensure to provide care by telemedicine, Dr. Horton noted. The American Telemedicine Association (ATA) and the Center for Telehealth & eHealth Law offer current information on specific state requirements.
“Reimbursement depends of the payer, Medicare, Medicaid, or private insurance, and the services provided, screening, diagnosis, or management,” he said. “Assistance can be obtained from the ATA and the American Academy of Ophthalmology.”