![]() ![]() The Pictor Plus (Volk Optical, Mentor OH) is a relatively inexpensive, hand-held fundus camera with a 45° field of view (nine times that of a standard direct ophthalmoscope). Such a program might also improve monitoring of chronic retinal pathology, such as DR, and improve long-term patient outcomes. If medical students can quickly obtain high quality images of the retina with minimal interruption to clinic workflow, patients with retinal disease might be triaged efficiently when these communities do receive ophthalmologic care. ![]() Īs medical students frequently volunteer to provide medical care abroad, there may be utility in utilizing medical students in ophthalmologic telemedicine screening programs. Telemedicine screening for DR is the most well-validated of the ocular telemedicine programs –, but there is evidence to support telemedicine screening and handheld portable fundus camera use for AMD, suspicious optic nerve, retinopathy of prematurity, and papilledema, as well, –. Although non-ophthalmic health care providers typically report lower levels of confidence with direct fundoscopy and demonstrate lower DR screening accuracy compared to trained ophthalmologists –, the wider field of view may help alleviate this concern. Furthermore, compared to direct ophthalmoscopy, hand-held retinal cameras provide a wider field of view, and have demonstrated improved diagnostic accuracy of DR and optic disc edema by non-ophthalmologic providers to levels comparable with ophthalmologists –. Both hand-held and tabletop retinal cameras have been used to acquire clinically useful images of the retina –. ![]() Telemedicine screening programs using digital fundus photography have shown promising results in the remote diagnosis of DR –, –. One possible solution to this care gap may come in the form of telemedicine. However, only very rarely do they have an on-site ophthalmologist, which creates a gap in access to care in the realm of retinal disease. This organization is primarily run by volunteer family medicine, emergency medicine, or internal medicine physicians from the United States and Europe, as well as those from Central and South America. The primary healthcare provider for the greater than 25 isolated island communities in this region is a non-profit organization stationed in Bocas del Toro (entitled “The Floating Doctors”). In particular, Bocas del Toro is a remote archipelago in western Panama where inhabitants lack access to reliable health care. Rural populations with limited access to medical care are frequently targets of medical aid organizations –. Further complicating the picture, screening for retinal pathology is considerably more difficult than anterior ocular conditions multiple studies have demonstrated that the accuracy of DR screening by non-ophthalmic health care providers is lower than rates achieved by ophthalmologists and retinal specialists –. Retinal pathology is becoming a larger issue as the global population ages and the prevalence of diabetes increases each year. ![]() In addition, AMD is the leading cause of blindness in people older than 65y worldwide. For instance, the global prevalence of DR is estimated at 35.4%, and as the global incidence of diabetes rises, the burden of visual disease from DR is expected to increase. Retinal pathology may represent an underappreciated contributor to the global burden of eye disease. While the majority of the global burden of ocular disease is a result of untreated cataracts, other major contributors include posterior segment conditions such as glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). Furthermore, up to 75% of blindness is considered to be avoidable. Of the 300 million visually impaired individuals worldwide, 90% live in developing countries. Visual impairment causes a significant global economic burden, resulting in an estimated 30.2% relative reduction in employment and 0.3% GDP loss. ![]()
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