Sangeeta Das, B.Optom

Clinical Optometrist, Army Base Hospital, Assam


The field of information technology (IT) has grown significantly in recent years. Clinical treatment has also been transformed by the internet. IT interventions and consultations are being rolled out across the health-care system at a rapid pace and on a wide scale. Tele ophthalmology is a phrase that describes the field of vision science, that helps to organize patient care and improves the expertise of local eye care providers including community optometrists and ophthalmic nurses. There are two types of telemedicine consultations available (1) : ‘Synchronous telemedicine’ makes use of telecommunications to allow for real-time interactions between doctors and patients. It basically includes the presence of both parties using a communication source for real time interactions. Real-time telehealth enables prompt care, particularly in emergency or critical situations, and supports the doctor-patient relationship by allowing face-to-face analysis and treatment. The doctor can see the patient, perform an examination, and converse with him or her much like in an office visit. However, telemedicine that includes the capture of patient data and subsequent analysis by a remote expert is known as ‘storeandforward’ or ‘asynchronous’ telemedicine. Asynchronous telemedicine entails gathering medical data and transferring it to a doctor or medical specialist for offline interpretation at a convenient moment. Patients can receive prompt specialty care without having to travel outside of their primary care provider’s clinic with this form of consultation. Wait times for specialty care are reduced, especially in places where medical specialists are in shortage.

Ophthalmic disorders necessitate prompt evaluation and management, putting a strain on the outpatient facilities needed to manage ocular care.(2) Tele-ophthalmology offers an alternative model of service which could help ophthalmic care accessibility and demand. For example: the increasing trend of diabetes and its ocular consequences, myopia and screen exposure and uncertain condition of travelling to a tertiary eye care centre at a reliable time could overcome by the means of tele-ophthalmology in the present scenario as well as in near future. Perhaps best illustration of teleconsultation is diabetic retinopathy screening, which has several screening programmes in use across the world (Figure 1).(3-5) Furthermore, since tele-consultation is still a developing area of medical field, there are several hurdles to overcome. However, these barriers can be conquered soon if any suitable measures are taken (Table 1).

Figure 1:  Common ocular conditions where telemedicine would play a major role


Table 1: Common barriers of telemedicine and ways to overcome those

Barriers Solutions
Unfamiliarity with tele-consultation (6)
  • Adequate training of tele-consultation for the health care providers
  • User friendly platform for patients
Lack of confidence on its accuracy (7)
  • Identifying ocular conditions that can be well managed with teleconsultation
Poor clinical image quality (8)
  • Adequate training of the individual handling the machine
Security and privacy issues (9)
  • Ensuring confidentiality of patient’s data in the platform being used
Lack of trained staff availability (10)
  • Implementing a trained team


Telemedicine is ideally suited to the treatment of ophthalmic patients especially in diabetic retinopathy,(11) retinopathy of prematurity,(12) glaucoma screening and diagnostics,(13) age related macular degeneration (14) and prescribing glasses and contact lenses.(15) Tele ophthalmology has applications in both urban and rural areas. Emergency eye care, diabetic eye screening, and virtual macular and glaucoma clinics are all improving thanks to better integration of tele ophthalmology with local services. Tele ophthalmology aids in cost-cutting while increasing productivity, as well as reducing patient travel and transfer. Tele ophthalmology consultations are not meant to replace face-to-face ocular consultations and clinical examinations. In the digital age, electronic referral of ocular photographs rather than people is a beneficial and quick method for assisting, prioritizing, and refining referral of many ophthalmic patients, particularly retinal patients.




  1. Kulshrestha, Manoj & Kelly, Simon & Mahmood, Usman. (2011). Teleophthalmology in Practice. 10.5772/18175.
  2. Sim DA, Mitry D, Alexander P, et al. The evolution of teleophthalmology programs in the United Kingdom: Beyond diabetic retinopathy screening. J Diabetes Sci Technol 2016; 10: 308–317.
  3. Chin EK, Ventura BV, See KY, et al. Nonmydriatic fundus photography for teleophthalmology diabetic retinopathy screening in rural and urban clinics. Telemed J e Health 2014; 20: 102–108.
  4. Zimmer-Galler IE, Kimura AE and Gupta S. Diabetic retinopathy screening and the use of telemedicine. Curr Opin Ophthalmol 2015; 26: 167–172.
  5. Crossland L, Askew D, Ware R, et al. Diabetic retinopathy screening and monitoring of early-stage disease in Australian general practice: Tackling preventable blindness within a chronic care model. J Diabetes Res 2016. DOI: 10.1155/ 2016/8405395.
  6. Liu Y, Zupan NJ, Swearingen R, Jacobson N, Carlson JN, Mahoney JE, et al. Identification of barriers, facilitators, and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic: A qualitative study. BMJ Open 2019;9:e022594.
  7. Siwicki B. 2020 April 03. Survey‑americans‑ perceptions telehealth‑covid19‑era. Available from survey‑americans perceptions‑telehealth‑covid19‑era.[last accessed on 16 may-2021]
  8. Mansberger SL, Sheppler C, Barker G, Gardiner SK, Demirel S, Wooten K, et al. Long‑term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: A randomized clinical trial. JAMA Ophthalmol 2015; 133:518‑25.
  9. Hall JL, McGraw D. For tele health to succeed, privacy and security risks must be identified and addressed. Health Aff (Millwood) 2014; 33:216‑21.
  10. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare 2016; 24:4‑12
  11. Rathi S, Tsui E, Mehta N, Zahid S, Schuman JS. The Current State of Teleophthalmology in the United States. Ophthalmology. 2017;124(12):1729–1734. doi:1016/j.ophtha.2017.05.026.
  12. Wang SK, Callaway NF, Wallenstein MB, Henderson MT, Leng T, Moshfeghi DM. SUNDROP: six years of screening for retinopathy of prematurity with telemedicine. Can J Ophthalmol. 2015Apr;50(2):101–106. doi:1016/j.jcjo.2014.11.005.
  13. Kiage D, Kherani IN, Gichuhi S, Damji KF, Nyenze M. The muranga teleophthalmology study: comparison of virtual (teleglaucoma) with in-person clinical assessment to diagnose glaucoma. Middle East Afr J Ophthalmol. 2013Apr-Jun;20(2):150–157. doi:4103/0974-9233.110604.
  14. Hadziahmetovic M, Nicholas P, Jindal S, Mettu PS, Cousins SW. Evaluation of a remote diagnosis imaging model vs dilated eye examination in referable macular degeneration. JAMAOphthalmol. 2019Jul1;137(7):802–808. doi:1001/jamaophthalmol.2019.1203.
  15. Jeganathan VSE, Valikodath N, Niziol LM, Hansen S, Apostolou H, Woodward MA. Accuracy of a smartphone-based autorefractor compared with criterion-standard refraction. Optom Vis Sci. 2018Dec;95(12):1135–1141. doi:1097/OPX.0000000000001308.