ABSTRACT
With the development of technology, doctors can diagnose and treat many diseases through telemedicine. At present, teleophthalmology is mainly used in screening and diagnosing some ocular diseases, monitoring chronic ocular diseases, as well as teleconsultation. With the increasing demand and application of teleophthalmology, some problems will gradually become prominent, such as insufficient equipment and staff, medical risks, patient acceptance and satisfaction, network security, privacy, and covering of medical insurance. The global pandemic of COViD-19 has unexpectedly brought telemedicine to the forefront of ophthalmic services, and may continue to change the way of ophthalmic diagnosis and treatment. With the development of artificial intelligence technology, the expansion of 5G communication network coverage, the standardized training of primary medical staff, and the introduction of relevant laws and regulations, teleophthalmology will become more improved, universal, and widely applied, so as to provide patients with sustainable medical services of higher quality.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.
ABSTRACT
Advances in neonatal medicine have progressively increased the survival of premature infants. Increased survival has however come at the cost of increased number of infants with prematurity-related complications. This is represented by high rates of respiratory distress syndrome, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), sepsis, periventricular leukomalacia (PVL), intraventricular haemorrhage (IVH), cerebral palsy, hypoxic ischaemic encephalopathy (HIE) and visual and hearing problems in survivors. In addition to prolonged hospital stay after birth, readmission to hospital in the first year of life is common if chronic lung disease exists. Around 3% of newborns have a congenital physical anomaly with 60% of congenital anomalies affecting the brain or heart and around 1% having multiple anomalies. Individual congenital conditions requiring surgical intervention in the neonatal period are rare. Neonates have a higher perioperative mortality risk largely due to the degree of prior illness, the complexity of their surgeries, and infant physiology. The maintenance of oxygenation and perfusion in the perioperative phase is critical as both affect cerebral perfusion and neurocognitive outcome but the triggers for intervention and the thresholds of physiological parameters during neonatal anaesthesia are not well described. After even minor surgical procedures, ex-premature infants are at higher risk for postoperative complications than infants born at term.Copyright © 2022
ABSTRACT
Purpose of Study Retinopathy of prematurity (ROP) is the abnormal development of retinal vessels in preterm infants which can lead to severe visual impairment or blindness. Many premature infants require ophthalmology follow-up if the retinae have not fully matured at the time of discharge. Ophthalmology follow-up is crucial as these infants are at risk for poor visual development, especially if changes that require intervention are not detected in a timely manner. Adequate pupillary dilation is necessary for an optimal eye exam and requires installation of eye drops at least 1 hour prior to the exam in the doctor's office. This wait time increases the likelihood of exposure to other people and infection. During the COVID-19 pandemic, our NICU adopted a discharge policy of teaching parents how to instill eyes drops to their infants at home before leaving for the eye appointment, with the goal of reducing the wait time in the office prior to the examination. The goal of this study is to evaluate if instillation of eye drops by parents at home before going to the office will provide adequate pupillary dilation for optimal ROP exam of premature infants in the outpatient setting and reduce wait time in the ophthalmology office. Methods Used Parents of all preterm infants needing follow-up ROP exam were provided with and taught how to instill eye drops at home before leaving for the ophthalmology appointment. Parents were given a paper log and documented the time and number of eye drops instilled. The ophthalmology office then documented check-in time, time of exam and adequacy of pupillary dilatation. A sample log is included (figure 1). Summary of Results Of the 14 individual eyes that were dilated, 10 were adequately dilated when eye drops were instilled by parents. 2 eyes received only one eye drop but were adequately dilated. 2 eyes did not adequately dilate with two drops in each eye and required three drops prior to the subsequent follow-up. 2 eyes received two drops but did not dilate adequately. The average time from check-in to eye exam was 38 minutes. Conclusions As premature infants are at higher risk for infection, a process to allow for efficient outpatient evaluation is necessary. 71% of eyes were adequately dilated when parents instilled the eye drops prior to the first follow-up appointment. Of the eyes that were not adequately dilated, when parents were instructed to increase the number of drops prior to the second follow-up, both eyes were adequately dilated. Our study shows that parents are capable of instilling eye drops to provide optimal dilation for the ROP exam, thus decreasing the time spent in the outpatient office. (Table Presented).
ABSTRACT
Background: Over 700,000 New Zealanders (NZ), particularly elderly and Māori, live without timely access to specialist ophthalmology services. Teleophthalmology is a widely recognised tool assisting in overcoming resource and distance barriers. The aim was to conduct a systematic review identifying, describing and contrasting teleophthalmology services in NZ with the comparable countries of Australia, USA, Canada and the United Kingdom, also assessing any changes to programs pre- and post-COVID-19 pandemic. Method: The electronic databases Embase, Pubmed, Web of Science, Google Scholar and Google were systemically searched in August 2020, filtered to the countries above, then again in June 2021 to gather COVID-19 pandemic teleophthalmology literature. Results: A total of 128 studies were identified describing 108 discrete teleophthalmology services. Articles spanned from 1997-2021. Models were categorised into general eye care (n = 16;14.8%) emergency/trauma (n = 6;5.5%) school screening (n = 13;12%), artificial intelligence (n = 19;17.5%) and disease specific models of care (n = 54;50%). The most common diseases addressed were diabetic retinopathy (n = 22;20.3%), retinopathy of prematurity (n = 12;11%) and glaucoma (n = 9;8.3%). Typically models involved local clinicians transmitting images or video, usually fed-forward. The second search yielded 14 COVID-19-based teleophthalmology services, involving significantly increased home monitoring, telephone/video live-consults. Conclusion: Teleophthalmology will play a crucial role in the future of eye care. COVID-19 offers a unique opportunity for improvement and expansion of teleophthalmology. Feed-forward and increasingly, live-based teleophthalmology services have demonstrated feasibility and cost-effectiveness in similar countries internationally. New Zealand's should invest in strategic partnerships and technology nationally to improve eye health equity.