Telemedicine model to prevent blindness from familial glaucoma

Authors

  • Sandra E Staffieri BAppSci(Orth),

    1. Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria
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  • Jonathan B Ruddle FRANZCO,

    1. Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria
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  • Lisa S Kearns BOrth,

    1. Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria
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  • Julie M Barbour DOBA,

    1. Launceston Eye Institute, Launceston
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  • Thomas L Edwards MBBS PhD,

    1. Royal Hobart Hospital/University of Tasmania, Hobart, Tasmania
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  • Padma Paul MS,

    1. Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria
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  • David A Mackey MD FRANZCO

    Corresponding author
    1. Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria
    2. Royal Hobart Hospital/University of Tasmania, Hobart, Tasmania
    3. Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
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Professor David A Mackey, Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, 2 Verdun St, Nedlands, WA 6009, Australia. Email: david.mackey@lei.org.au

Abstract

Background:  To develop, implement and evaluate a telemedicine model to reduce glaucoma blindness through the early detection of undiagnosed glaucoma in high-risk individuals.

Design:  Prospective study, private ophthalmology practice and public outpatient clinics in Tasmania.

Participants:  One hundred and thirty-three individuals with primary open-angle glaucoma were invited to enrol their first-degree relatives (FDRs) to undergo an eye examination. Within the study period, 211 FDRs were available for examination.

Methods:  A registered nurse was trained to perform the required assessments. Clinical data were entered into a purpose-built database, converted to a portable document format and graded offsite by an ophthalmologist to determine the presence, absence or risk of developing glaucoma. Participants were notified of the grading result and recommendations for review.

Main Outcome Measures:  Incidence of undiagnosed glaucoma in a high-risk population.

Results:  Previously undiagnosed glaucoma was identified in 5% of those examined. For every 19 participants screened, one new case of previously undiagnosed case of glaucoma was identified. Additionally 15% of participants showed suspicious signs of glaucoma, and 6% had ocular hypertension.

Conclusions:  A telemedicine model is an efficient method for screening, grading and notifying participants of examination results. Nurses can be adequately trained to undertake the initial screening examinations, with grading of the results performed offsite by a suitably qualified ophthalmologist. Targeted screening for glaucoma increases the yield of identifying individuals with undiagnosed glaucoma or those at greatest risk. Cost efficiencies for this model of glaucoma screening should be further explored and implemented to prevent blindness from familial glaucoma.

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