People displaying enhanced pressure within the eyeball incur the risk to suffer from glaucoma sooner or later. Optometrists will particularly screen those patients whose eye-measurement results look suspicious and also persons with a family history of glaucoma. At the Ophthalmology Unit in Rotterdam, a two-year experiment has been set up to perform optometry from a distance. The project enables ten local optometrists to transmit real time video-images to the hospital. The tele-optometry initiative introduces medical expertise to the opticians whereas the workload for ophthalmologists is substantially being reduced. In addition, the optic measurement results will be used for scientific research.
In optometry, laser technology is being applied in order to take images from the area situated around the optic nerve. In emergency cases, three glaucoma-experts at the Ophthalmology Clinic in Rotterdam can view the images simultaneously. The measurement data, including the images, are electronically transmitted to the hospital. The tele-consultation project aims to avoid patient overload in the ophthalmology centre in order to build off the long waiting lists for those who need urgent surgery. The experiment requires a serious investment in equipment and software from the part of the optometrists to conduct the glaucoma investigation. At the end of 1999, the project has to be fully operational.
The technical infrastructure is being implemented by Joanknecht & Vieveen, a company which has been active in the health care sector as a provider of Electronic Data Interchange (EDI) networking solutions. ISDN connections will be installed for communications at a bandwidth speed of 128 kilobit per second. Standard compression techniques will be applied for smooth image transfer. The ten participating optometrists have specialized software at their disposal, as well as an ISDN-connection and a laser device. The price for one laser head amounts to approximately 75.000 euro which is quite expensive. Therefore, only three laser heads will be purchased, one of which will have to circulate among the different practitioners. Patients can report themselves at regular times for examination.
The oculist and the optometrist can view the same images simultaneously in real time, use the mouse for pointing out particularities to each other, and discuss cases via the audio-connection. Next to the images, calibration and hall-mark information is being transmitted to enable adequate comparison between the various measurement values. Because of their high-qualified education, optometrists are usually employed by specialized opticians. The project will offer an excellent occasion to assess the level of quality delivered by the optometrists and investigate whether further improvement is needed. Eventually, the Ophthalmology Hospital will grant the selected optometrists certification.
The project team equally studies to which extent it would be useful to involve general practitioners in the experiment. The general idea is to transmit the outcomes which could be of particular relevance to the general practitioner. In turn, the physician has to be willing to refer patients to the optometrist. In the case of glaucoma, it is essential to make the diagnosis in an early stage in order to prevent incurable damage. Ophthalmologists participating in the project therefore could immediately offer a second opinion in serious cases. Included is also the building of a database to perform the hall-marking of the equipment as well as statistical analyses.
Overnight, all new measuring data is being transmitted to a central server in the Ophthalmology Unit. Since the information consists of video images, an algorithm has been developed by Joanknecht to reduce the communication costs. This algorithm will be extensively tested within the experiment. The project offers patients a chance to visit their local optician for a high-quality examination of their eyes. Whenever a specialized intervention is required, referral to and treatment by an ophthalmologist can be arranged much faster than before. The optometrists will receive the opportunity to upgrade their image and extend their responsibilities whereas the Opthalmology Hospital will be able to perform more examinations and put the focus on cases where specialized help is truly needed.
In The Netherlands, there are about 180.000 glaucoma-patients but there is an acute shortage of oculists. By involving the optometrists in the project, the Ophthalmology Hospital in Rotterdam aims at reducing the standardized examinations within the clinic. The innovative techniques for tele-optometry enable the oculists to focus on the real eye diseases. In the long run, the project stands a fair chance to be extended to the national level. The global costs for the two-year initiative amount to 350.000 euro, a part of which is being supplied by Senter and another one by the Ophthalmology Unit and the participating optometrists. As the source to this article, we refer to the Automatisering Gids.