Abstract
Telemedicine has traditionally been applied within remote settings to overcome geographical barriers to healthcare access, providing an alternate means of connecting patients to specialist services. The coronavirus 2019 pandemic has rapidly expanded the use of telemedicine into metropolitan areas and enhanced global telemedicine capabilities. Through our experience of delivering real-time telemedicine over the past decade within a large outreach eye service, we have identified key themes for successful implementation which may be relevant to services facing common challenges. We present our journey toward establishing a comprehensive teleophthalmology model built on the principles of collaborative care, with a focus on delivering practical lessons for service design. Artificial intelligence is an emerging technology that has shown potential to further address resource limitations. We explore the applications of artificial intelligence and the need for targeted research within underserved settings in order to meet growing healthcare demands. Based on our rural telemedicine experience, we make the case that similar models may be adapted to urban settings with the aim of reducing surgical waitlists and improving efficiency.
Highlights
The delivery of equitable eye services for rural and remote communities represents a unique challenge to healthcare providers
This article presents an overview of our journey toward the development of an integrated teleophthalmology model over the past decade, with a focus on the key lessons for building an effective telemedicine service
Within Western Australia (WA), integration of teleophthalmology has been a crucial component in enabling Lions Outback Vision to make progress toward equitable eye care delivery
Summary
The delivery of equitable eye services for rural and remote communities represents a unique challenge to healthcare providers. In 2011, Lions Outback Vision implemented real-time videoconference teleophthalmology services that linked patients to an ophthalmologist and was facilitated by their primary healthcare provider. Collaborative care models involving communitybased optometrists and virtual review by an ophthalmologist using “store-and-forward” telemedicine modalities have been demonstrated for glaucoma and diabetes clinics in Australia, leading to cost-savings and reduced wait times [21, 22]. Urban centers in the United Kingdom have explored comparable models involving community optometrists and telemedicine consultations to enable “one stop cataract surgery,” demonstrating similar benefits [24, 25] Adapting these models to the Australian context will require careful consideration to safeguard informed consent, rigorous surgical risk-assessment, and effective use of theater-time, the benefits warrant further exploration. Telemedicine provides a seamless path from primary care to surgical management, and enables expert medical input where required, establishing a cornerstone to collaborative care
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