**5. Conclusion**

Governments are now focusing on delivering care closer to the patient's home. With the ever increasing number of patients we need to see in our clinics, these clinically driven IT solutions may allow patients to have investigations carried out either in their local community hospitals, primary care setting or in mobile ophthalmic units. The various solutions discussed in this chapter using wireless technology to set up virtual clinics will:


We would envisage that this will help to reduce slippage on patient appointments, distribute the workload to the community staff and help to increase capacity. This will help to reduce also the travel burden on patients traveling to the main centre every month for some patients. This becomes increasingly more difficult for elderly patients with time, and saves them many hours of a long trip, with reduced need for hospital transport, or patients own transport costs in many instances. There is also reduced pollution directly arising from reduced travel needs.

## **Author details**

The Retcam does require contact with the cornea and will therefore require training. It uses pupillary illumination to take digital photos of the fundus and skilled screeners may grade these images in a central location that can be remote from the neonatal unit. Where a shortage of trained paediatric ophthalmologists is stretching the services of ROP screening, this mode of teleophthalmology is not only valuable, but is in fact the only solution to maintaining a credible service. Other paediatric ophthalmic pathology can also be excluded via the retcam.

to be made on urgency of referrals. Photographs of shaken babies for diagnostic and medico legal purposes can also be taken via a Retcam and the images subsequently transferred for

Advantages of the Retcam include its portability and manoeuvrability in constrained areas such as on the Neonatal Intensive Unit and outpatients. It is easily transportable between hospitals and clinics, and allows transfer of images to any networked system. It allows timely remote evaluation of patient images and provides advanced image analysis and comparison

In 2008 at Nayayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India, a tele ROP service was initiated using a nonphysician screening model as described by Vinekar A (2008). This was entitled KIDROP (Karanataka Internet Assisted Diagnosis of ROP). The Retcam Shuttle (clarity MSI) and a portable laser indirect ophthalmoscope were transported by a clinical team to 23 Neonatal Intensive Care Units in 7 districts around Bangalore city.

The images are exported from a laptop using a portable wireless data card which allows internet access. The images are uploaded onto a secure server using an n indigenously designed software (i2i Telesolutions;Bangalore, India), which are backed up at 2 geographic

Since 2009, images have been visualised on a smart phone remotely using a specially designed application for the device. The reports created on the smart phone are in PDF, and on sub‐ mission to the expert, they enter the server through the GSM cellular network and are accessible

Governments are now focusing on delivering care closer to the patient's home. With the ever increasing number of patients we need to see in our clinics, these clinically driven IT solutions may allow patients to have investigations carried out either in their local community hospitals, primary care setting or in mobile ophthalmic units. The various solutions discussed in this

sites. A remotely situated expert will login read and report the image live.

chapter using wireless technology to set up virtual clinics will:

**•** Effectively educate hospital staff, clinicians and the community

**•** Increase productivity of healthcare professionals

**•** Strengthen referral patterns

in an eye with a white reflex, allowing decisions

An example is the presence of retinoblastomas4

to the technician in any remote rural area.

**5. Conclusion**

capability of previous images with retcam review software.

opinion.

22 Telemedicine

Daniel Dragnev1 , Usman Mahmood1 , Chris Williams2 and Manoj Kulshrestha1

1 Hywel Dda Health Board, UK

2 Betsi Cadwaldr University Health Board, UK

#### **References**


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[15] Lamirel, C, Bruce, B, Wright, D, Newman, N, & Biousse, V. (2012). Nonmydriatic Digital Ocular Fundus Photography on the Smart Phone 3G: The FOTO-ED Study

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24 Telemedicine

1515-1519.


**Chapter 2**

**Telemedicine in Management of Retinoblastoma**

Retinoblastoma is a highly malignant tumor of the eye that manifests most often in the first 3 years of life. Early detection is essential to preserve visual function, and decrease mortality from retinoblastoma. Late diagnosis globally results in up to 70% mortality; where optimal

Telemedicine has many possible applications in ophthalmology, from community screening to the provision of expertise in areas where it is otherwise not available. Broad-based appli‐ cations of telemedicine could greatly enhance screening efforts for potentially blinding conditions such as diabetic retinopathy, macular degeneration, glaucoma, retinopathy of prematurity as well as retinoblastoma. In this chapter we discuss specifically the application of telemedicine in management of retinoblastoma. Telemedicine can help to bring subspecialty

Retinoblastoma is the most common intraocular malignancy of childhood.[1] It represents about 4% of all pediatric malignancies, and affects approximately 1 in in 20,000 live births each year.[2] Most studies indicate that the incidence of retinoblastoma among various geographic populations is relatively constant. There is a 95% survival rate in developed countries, however the worldwide survival rate is closer to 50%. This is largely due to earlier detection in devel‐ oped countries, when the tumor is still confined to the globe. This is in contrast to underde‐ veloped areas where retinoblastomas are often diagnosed at an advanced stage, when they

> © 2013 Moran O' Keefe and ; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Moran and O' Keefe, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

expertise to small or rural communities, as well as to the developing world.

Sarah MoranMichael O' Keefe

Sarah Moran and Michael O' Keefe

http://dx.doi.org/10.5772/57019

**1. Introduction**

**2. Retinoblastoma**

have already invaded the orbit or brain.

**2.1. Epidemiology**

Additional information is available at the end of the chapter

therapy is accessible, more than 95% of children are cured.
