Abstract
Interest in teleophthalmology has been growing, especially during the COVID-19 pandemic. The advent of fifth-generation (5G) wireless systems has the potential to revolutionize teleophthalmology, but these systems have not previously been leveraged to conduct therapeutic telemedicine in the ophthalmology field. To assess the feasibility of 5G real-time laser photocoagulation as a telemedicine-based treatment for diabetic retinopathy (DR). This was a prospective study involving a retinal specialist from the Peking Union Medical College Hospital in Beijing, China, who performed online 5G real-time navigated retinal laser photocoagulation to treat participants with proliferative or severe nonproliferative DR who had been recruited in the Huzhou First People's Hospital in Zhejiang Province, China, located 1200 km from Beijing from October 2019 to July 2020. These teleretinal DR and laser management procedures were conducted using a teleophthalmology platform that used the videoconference platform for teleconsultation, after which telelaser planning and intervention were conducted with a laser system and a platform for remote computer control, which were connected via 5G networks. Diabetic eye prognosis and the real-time laser therapy transmission speed were evaluated. A total of 6 participants (9 eyes) were included. Six eyes were treated via panretinal photocoagulation alone, while 1 eye underwent focal/grid photocoagulation and 2 eyes underwent both panretinal photocoagulation and focal/grid photocoagulation. The mean (SD) age was 53.7 (13.6) years (range, 32-67 years). The mean (SD) duration of diabetes was 14.3 (6.4) years (range, 3-20 years). The mean (SD) logMAR at baseline was 0.32 (0.20) (20/30 Snellen equivalent). Retinal telephotocoagulation operations were performed on all eyes without any noticeable delay during treatment. The mean (SD) number of panretinal photocoagulation laser spots per eye in 1 session was 913 (243). This study introduces a novel teleophthalmology paradigm to treat DR at a distance. Applying novel technologies may continue to ensure that remote patients with DR and other conditions have access to essential health care. Further studies will be needed to compare this approach with the current standard of care to determine whether visual acuity or safety outcomes differ.
Highlights
This study introduces a novel teleophthalmology paradigm to treat diabetic retinopathy (DR) at a distance
Applying novel technologies may continue to ensure that remote patients with DR and other conditions have access to essential health care
Owing to the unique structural properties of the eye, which enable clinicians to directly visualize the neural tissue, connective tissue, vasculature, and any retinal or choroidal lesions, ophthalmology has been at the forefront of practical advances in telemedicine.[1]
Summary
This was a double-site, nonrandomized, prospective study performed between Peking Union Medical College Hospital (PUMCH) in Beijing, China, and Huzhou First People’s Hospital in Huzhou, China (eMethods and eFigure 1 in the Supplement). Institutional review board approvals were obtained from both PUMCH and Huzhou First People’s Hospital. All study participants provided written informed consent specific for 5G real-time telemedicine-mediated laser photocoagulation, and all evaluations and laser treatments in this study were free for participants as compensation. The study was conducted in accordance with the tenets of the Declaration of Helsinki.[5]
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