The innovation allows Dr. Pop to carry out remote microscopic examinations of a patient's eye from his office in Montreal, while the patient is in the Hull clinic, or vice versa. Even when he is out of the country, Dr. Pop will be able to do the same thing, via a conference room equipped with a digital camera and an image compression/decompression system. He can equally use this tool to consult with various colleagues throughout the world who, without leaving their respective locations, will be able to examine a patient in the Montreal or Hull clinic.
The idea of developing a tele-consultation service is the result of Dr. Pop's desire to build an international network of ophthalmological specialists and allow them to interact with one other, regardless of geographical boundaries. One of Dr. Pop's colleagues, Dr. Julian Stevens of Moorfields Eye Hospital in London, is currently using a similar system. "We wanted to develop a service like this years ago, but the technology was simply not ready at that point", explained Dr. Pop. "Today's innovations, however, deliver exceptional image quality, a significant factor when you have to deal with the microscopic details involved in eye examinations."
"It goes without saying that at this point in time using telemedicine for pre-operative examinations and actual medical procedures is unthinkable. But in charting a patient's progress or performing post-op assessments, the quality of care is absolutely identical. The patient and I can actually see and talk to each other as if we were in the same room. The technology we use is uninvasive, which makes it easier and quicker for patients to adapt to this new environment. One of the primary advantages of telemedicine is that it lets us connect with specialists and tap into their expertise. This is precisely what we had in mind when we started this initiative", added Dr. Pop.
Both the Hull and Montreal examining rooms are provided with the same equipment, including a 27-inch television screen, a digital telephone system, two digital cameras, a Compression/Decompression Video (CODEC) image compressor and a slit-lamp microscope, a device which makes it possible to carry out precision eye examinations. The physician's face is visible to the patient at all times, and the doctor can choose between viewing the patient's face or the image being transmitted by the digital camera attached to the slit lamp. The establishment of a visual link between the two sites is as easy as dialling into a digital telephone line.
The nurse operating the slit lamp adjusts the microscope to see the patient's eye. This very image is then carried to the digital camera mounted on the slit lamp by a beam splitter. A variety of controls enable the focus to be adjusted accordingly. The view captured through the microscope eyepiece is enlarged to 800 x 600 (S-VGA) resolution, a significant advantage. The physician can select the desired view via the image compressor, either from the camera transmitting images of the examination room and its occupants, or from the camera attached to the slit-lamp microscope.
"Digital telephony has played an important role in the success of this project", stated Yves Payette, a biologist and research assistant at the Michel Pop Clinics. "We use six digital ISDN lines, the equivalent to twelve digital telephone lines of 768 kbps. In comparison with a high-speed Internet connection of 1 to 2 Mbps, whose bandwidth cannot be sustained on an uninterrupted basis by the server for more than a few seconds, digital telephony offers access to continuous bandwidth. We also decided to apply equipment elements from a Saint-Laurent-based multinational so that we can benefit from rapid and efficient technical service."
The Michel Pop Clinics are experts in private eye care in Quebec. The Hull and Montreal clinics specialise in Excimer laser (LASIK, PRK) treatment, cataract surgery, and intra-ocular lens implants. Research is an important part of their activities. Dr. Pop is highly regarded in the ophthalmology area. In Europe as well, a telemedicine platform is being built for ophthalmology services. You can read all about it in this month's VMW article Tele-ophthalmology no longer blind spot on the European map.