Utility of Virtual Eye Exam Using Teleophthalmology and its Accompanied Challenges
Recently I published a piece on the significance and utility of digital biomarkers in today's healthcare domain. Within the content, I tried to elaborate on various forms of data captured from diverse sources.
The concept of digital biomarkers is broad and based on the type of sensors used to collect data, metadata, and imaging. One can transmit some information via remote devices connected across cyberspace, yet others can connect directly through Telehealth platforms. One such emerging vision is Teleophthalmology.
In the recent decade, Telehealth has given annex to a remote means of examining human eyes using Teleophthalmology.
Eye examination, in general, is inherently a technology-dependent clinical undertaking. Thus incorporating Technology allows rendering eye exams more luxurious while expanding its point of care from a doctor's office to remote locations utilizing Teleophthalmology.
For instance, ophthalmologists (and Optometrists) typically use ophthalmoscopes and slit lamps in their local facilities to examine inner eye structures. With the modern advancements in eye diagnostic technologies, one can expect more digital and portable technologies to use in remote settings.
Indeed, today, the ability of eye specialists to use Teleophthalmology includes access for those living in rural and underserved neighborhoods to quality eye care services. Those include ophthalmologic disease screening, diagnosis, and monitoring of various eye ailments. Furthermore, smartphone applications of Teleophthalmology offer substantial functionality and potential for future innovations.
A Telehealth system requires additional sensors or a source of digital biomarkers, including cameras and lenses that can take and transmit visual images.
According to some reports, there has been a significant surge in research around Teleophthalmology. However, like its parent concept, the Telehealth system, it is associated with a grey zone. That comprises the lack of sufficient data exchange standardization, liability issues, and cost associated with its implementation.
Some leaders advocate for a global Teleophthalmology society that can establish a worldwide evidence-based standard and help maintain this novel practice's legal and ethical principles.
Recent Trends in Teleophthalmology
Despite sundry unclear perspectives around the utility of Teleophthalmology, one can foresee its application in screening and monitoring some chronic and acute ocular diseases. Those are eye disorders, including Glaucoma, Diabetic retinopathy, or retinal damage due to uncontrolled diabetes and numerous external eye problems.
A recent Israeli pilot program, the Teleophthalmology screening project, points to the effective detection of various ocular diseases in underserved areas with the potential to allow early diagnosis and prevention of vision loss and blindness in underserved areas.
Regulation and Ethical Implication of Teleophthalmology
Medicolegal and ethical uncertainties around the application of Teleophthalmology still leave open-ended questions. The specific guidelines as to how the medical community must use that Technology is still a matter of controversy.
Today, there's no clear policy addressing Teleophthalmology as a unique domain, as all general guidelines purely address Telehealth or the ophthalmology discipline.
The emergence of Teleophthalmology opens the door to new domains and challenges. Such challenges include public health, e-commerce, and personal data protection. They do so by allowing liberal movement of data and services, including consents, medical devices, pharmaceuticals, and, as mentioned earlier, digital biomarkers across geographic borders.
Likewise, medical professionals' and patients' rights and privacy must be the ultimate priority. That is by protecting data, holding freedom of choice for physicians, and maintaining the costs of cross-border healthcare. More precisely, in the event payer is the insurance, the benefit from cross-border Teleophthalmology care must follow the same eligibility standard.
Teleophthalmology providers must be able to uphold patient rights, continuity of care, and non-discrimination. Furthermore, they should bear liability issues while maintaining products and services that follow ethical standards, are equally accessible, and sustain the first do no harm principle.
Physicians treating patients over Teleophthalmology must act in the best interest of their patients just as if they are treating them in person, respecting patients' forbearance in selecting the treatment of their choice. Most of all, physicians must ensure patient privacy and the confidentiality of their information.
Obtaining informed consent must never be eliminated for Teleophthalmology encounters; an electronic consent form and signature should be created and authorized. And if the system or professional commits an error, disclosing medical errors is critical to note that certain aspects of the doctor-patient direct relationship that remote encounters may impact. The latter includes incidents such as eye contact and, thus, injury. That is precisely the main reason that despite the availability of remote Teleophthalmology-based meetings, physical office visits are still the golden rule of eye care.
- Ravulaparthi, Gayatri, and Subrahmanyam Chelluri. "Utility of Mobile Application-Based Teleophthalmology Services across India during the COVID-19 Pandemic." PubMed Central (PMC). Accessed November 13, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012949/.
- Liebertpub.com. “Liebertpub.Com.” Accessed November 13, 2022. https://www.liebertpub.com/doi/abs/.
- Mohammadpour, Mehrdad, Zahra Heidari, Masoud Mirghorbani, and Hassan Hashemi. "Smartphones, Tele-Ophthalmology, and VISION 2020." PubMed Central (PMC), December 18, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733521/.
- Bohacik, Stephen. "How Will An FDA-Cleared Online Eye Exam Affect Patients and Clinicians?" Optometry Advisor, October 7, 2022. https://www.optometryadvisor.com/general-optometry/how-will-an-fda-cleared-online-eye-exam-affect-patients-and-clinicians/.
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