How telemedicine can offer enhanced patient benefits

In 1994, Dr. Cuadros met an internist, a Harvard graduate with an interest in health-care technology, who showed him how to mount a digital camera on a slip lamp biomicroscope to capture images of patients' eyes. At the time, he said digital cameras were costly, around $9,000. Still, he invested his time and money, launching a new part of his career-telemedicine for eye care.

Branching into telemedicine

"Back then, I was glad to have somebody tell me that I didn't have to do anything but observe," he said. "It was nice that this patient didn't have to go through a lot of hassle. I was able to follow the patient-along with the ophthalmologist-until the hyphema was resolved. I thought this process could lead to something very important."

Since then, Dr. Cuadros also has reviewed tens of thousands of images from other healthcare providers via telemedicine. The exchange of clinical information enhances the delivery of patient care, he said.

Dr. Cuadros pointed to a Fresno, CA, primary care physician who routinely treated diabetic patients who never received eye exams. Several even went blind, he said. She acquired a digital retinal camera to include retinal exams as part of her chronic disease care model. Her assistants would snap pictures of her patients' eyes and transmit them to Dr. Cuadros who would diagnose their condition and recommend treatment and follow-up plans.

Global reach

The idea of global telemedicine began in 1999, when some optometry students attending University of California, Berkeley, were involved in a clinical rotation at Beijing Medical University. Dr. Cuadros set up a connection between the two schools so that optometry professors could see the various cases their interns were handling. Later, in 2001, as part of his doctoral dissertation, Dr. Cuadros created a web-based program called EyePACS (http://iyiyiy.eyepacs.org/).

The site now stores images of patients' eyes along with patient information that's sent by optometrists and other health-care providers worldwide. Over the past 4 years, he says the site has recorded more than 130,000 consults between optometrists, physicians, and ECPs.

Similarly, a U.S.-based ophthalmologist formed a humanitarian organization called Vision for All, working with the Health Ministry in Guanajuato, Mexico. The ministry purchased a retinal camera and asked primary care physicians to use it for eye exams, then passed the camera to doctors from town to town throughout Guanajuato. In 1 year, doctors performed 7,000 retinal exams, transmitting images of patients' eyes through EyePACS to a volunteer brigade of ECPs in the United States who reviewed the images for free over the Internet.

The EyePACS program also served as the prototype for the Aravind Eye Institute in India, the largest eye hospital in the world, to develop its own telemedicine program, and for La Salle University in Bogota, Colombia, to build its own teleoptometry clinic that now interacts with the program at UC Berkeley.

Telemedicine challenges

Despite its national and international growth and success, telemedicine has its own set of unique challenges. Dr. Cuadros said many insurance companies won't reimburse optometrists for providing this service, and awareness about the accuracy and effectiveness of these exams is still low.

Meanwhile, he added, the project is now focusing on diabetic retinopathy as part of a broader primary care blindness prevention program. "The whole idea is for optometrists to become part of a patient's health-care team instead of being on the outside," he said.

But that may take some time. He said optometrists first need to become more comfortable practicing telemedicine and more aware of the numerous patient benefits it offers.

"Telemedicine doesn't take the place of a regular eye exam but is instead the beginning of an eye exam that starts outside of the optometrist's office," Dr. Cuadros said. "This is a paradigm shift that takes awareness and living with the concept to be able to adopt it."

FYI

Jorge Cuadros, OD, PhD
Phone: 510/642-5456 E-mail: contact@eyepacs.org

Dr. Cuadros did not indicate a financial interest in the subject.