teleophthalmology

Teleophthalmology is a subspecialty of telemedicine that uses telecommunications technologies to provide ophthalmic care remotely. It enables screening, diagnosis, treatment planning, and follow-up across geographic barriers. The field employs two main modalities: store-and-forward teleophthalmology, in which images of the eye are captured and transmitted for asynchronous evaluation by a remote ophthalmologist; and real-time teleophthalmology, in which an ophthalmologist and patient interact via live videoconferencing. Mobile and point-of-care imaging devices, including smartphone-based fundus photography and portable slit-lamp or anterior segment imaging, have broadened access.

Common applications include screening for diabetic retinopathy, glaucoma risk assessment, retinopathy of prematurity screening in neonates, and monitoring age-related macular degeneration. Teleophthalmology also supports triage of ocular emergencies and postoperative follow-up in remote or underserved populations.

Benefits include increased access to eye care, earlier detection of sight-threatening diseases, reduced travel time and wait lists, and potential system-wide cost savings. Limitations include variability in image quality and technician training, dependence on reliable broadband, data security concerns, lack of universal reimbursement models, and regulatory or licensure barriers. Teleophthalmology is not a complete substitute for an in-person dilated examination when comprehensive assessment is needed.

Evidence from various programs indicates good sensitivity for diabetic retinopathy screening and acceptable diagnostic concordance with in-person exams, though results depend on setting and protocol. Ongoing developments include artificial intelligence-assisted image analysis, expanded mobile imaging, and standardized guidelines to improve interoperability and quality.