Real-time teleophthalmology in rural Western Australia

OBJECTIVE: This study aims to assess the current utilisation of a real-time teleophthalmology service for rural Western Australia (WA). DESIGN: Service evaluation by prospective audit. SETTING: Includes general practices, optometrists, hospitals in rural WA and the Lions Eye Institute in Perth. PARTICIPANTS: Eighty-five patients from rural WA participating. INTERVENTIONS: Video consultation (VC) with a general ophthalmologist. MAIN OUTCOME MEASURES: Number of referring practitioners and their locations, software and imaging equipment used as well as the presentation, working diagnosis and follow-up plan for each consultation. RESULTS: Eighty-five participants took part in a total of 100 VCs in the 5-month data collection period. There were 49 men (58%); age range 7-92 years; 31 identified as Indigenous Australian (37%). Participants were referred by optometrists (59%), hospital district medical officers (23%) and GPs (18%). Karratha (41%), Albany (20%) and Broome (14%) were the main VC locations. There were 31 different eye conditions managed; red eye, acute vision loss, known glaucoma and abnormal retinal photographs were the main presentations. Skype was the commonly used software (71%). Images were provided in 63% of all VCs. The main equipment used included digital retinal cameras (56%), smartphones (25%) and digital slit lamps (13%). An outpatient appointment with the ophthalmologist was recommended following 35 VCs. CONCLUSIONS: Optometrists used this service most frequently, despite a lack of financial incentive. Digital retinal cameras and smartphones were the most commonly used imaging modalities. Overall, real-time teleophthalmology was used in the management of a broad range of eye conditions and was a useful supplement to outreach ophthalmology services.