Tele-ophthalmology screening for retinal and anterior segment diseases

Abstract

A digital indirect ophthalmoscope (DIO) was developed and tested for use in tele-ophthalmology screening for posterior and anterior segment diseases. Using custom software, images from the DIO were digitized, compressed, stored and transmitted to a centralized eye clinic for interpretation. A total of 43 subjects were primarily screened for glaucoma using the DIO, a hand-held fundus camera and a stereo fundus camera. The photographic slides from the stereo fundus camera were used as gold standards. Images (390 × 300 pixels × 3 bits) were stored using a laptop computer together with patient information. Image quality received at the central eye clinic was good and showed adequate diagnostic information. An ophthalmologist estimated cup–disc ratios and graded the quality of the images. The sensitivity and specificity of each instrument was calculated. A high sensitivity and specificity was found when using the DIO, indicating that it could be used in tele-ophthalmic screenings. Further modifications are needed to make the instrument more user-friendly and to enable it to be used with undilated pupils, so that it can be easily operated by health-care personnel in remote areas. The camera can also be used to image gross external eye pathology.