Variability in Grading Diabetic Retinopathy Using Retinal Photography and Its Comparison with an Automated Deep Learning Diabetic Retinopathy Screening Software.

Background: Diabetic retinopathy (DR) screening using colour retinal photographs is cost-effective and time-efficient. In real-world clinical settings, DR severity is frequently graded by individuals of different expertise levels. We aim to determine the agreement in DR severity grading between human graders of varying expertise and an automated deep learning DR screening software (ADLS).

Teleglaucoma: improving access and efficiency for glaucoma care.

Teleglaucoma is the application of telemedicine for glaucoma. We review and present the current literature on teleglaucoma; present our experience with teleglaucoma programs in Alberta, Canada and Western Australia; and discuss the challenges and opportunities in this emerging field. Teleglaucoma is a novel area that was first explored a little over a decade ago and early studies highlighted the technical challenges of delivering glaucoma care remotely.

MEDLINE versus EMBASE and CINAHL for telemedicine searches.

Introduction: Researchers in the domain of telemedicine throughout the world tend to search multiple bibliographic databases to retrieve the highest possible number of publications when conducting review projects. Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) are three popular databases in the discipline of biomedicine that are used for conducting reviews. Access to the MEDLINE database is free and easy, whereas EMBASE and CINAHL are not free and sometimes not easy to access for researchers in small research centers.

A survey of the state of telemedicine in Western Australia.

To provide a baseline for future planning we conducted a survey of the use of telemedicine in the state of Western Australia. A questionnaire was designed, validated and posted to all public and private health-care facilities in Western Australia (metropolitan hospitals, country hospitals and nursing posts). Of the 132 questionnaires sent out, 102 were returned (77% response rate).

Health staff priorities for the future development of telehealth in Western Australia.

Introduction: The views of health managers and physicians working in non-metropolitan areas of Western Australia (WA) were sought about which telehealth services are most needed.

Method: Chief executives and nurse managers of rural hospitals were sent a simple, open-ended questionnaire and asked to consider the current health situation and problems in their area, and to list the four most-needed telehealth services. In addition, they were asked to hand the questionnaire to one of the GPs or medical officers working with them.

Automated determination of distance visual acuity: towards teleophthalmology services.

Purpose: The aim of this study was to evaluate the visual acuity scores of a computer-based visual function testing (CVFT) system. The automated chart uses logMAR notation (logarithm of the minimum angle of resolution) and randomised tilting E as optotype. The test was conducted using a laptop computer.

Telemedical diagnosis of anterior segment eye diseases: validation of digital slit-lamp still images.

Purpose: This study compared digital images from a portable slit-lamp camera with 35 mm slit-lamp photographs and traditional ophthalmic assessments in anterior segment disorder's detection.

Methods: A total of 196 patients (392 eyes) were recruited from an anterior segment ophthalmology clinic. Each patient underwent an examination by an anterior segment ophthalmologist.

Glaucoma screening: analysis of conventional and telemedicine-friendly devices.

Purpose: Portable, telemedicine-friendly devices offer novel opportunity for screening and monitoring glaucoma in the remote and rural regions of the world. This study examines the effective combination of telemedicine-friendly screening devices for detection of glaucoma in relation with conventional, hospital-based devices.

Methods: A total of 399 eyes were screened with telemedicine-friendly devices and conventional, hospital-based devices such as ophthalmoscope, tonometer and perimeter.

Telemedicine-friendly, portable tonometers: an evaluation for intraocular pressure screening.

Purpose: To evaluate the intraocular pressure (IOP) readings from two portable, telemedicine-friendly tonometers for suitability in glaucoma screening.

Methods: 213 eyes of 107 consenting patients attending an eye clinic were tested with an I-care tonometer and a Pulsair-Easy Eye puff-air tonometer. Gold standard IOP was measured with a Goldmann applanation tonometer (GAT).

Remote ophthalmology services: cost comparison of telemedicine and alternative service delivery options.

We calculated the cost of an established tele-ophthalmology service, from a health-provider's perspective, and compared this with the cost of three other existing eye-care service delivery options. During a 12-month study period, 118 persons took part in the tele-ophthalmology consultations between a rural clinic located approximately 900 km from the Lions Eye Institute in Perth. The variable costs of tele-ophthalmology were 166.

Emergency eye care in rural Australia: role of internet.

Purpose: Significant differences exist in the utilization of emergency eye care services in rural and urban Australia. Meanwhile, influence of internet-based technology in emergency eye care service utilization has not been established. This study aims to demonstrate, from a health provider perspective, an internet-based service's impact on emergency eye care in rural Australia.

Retinal image analysis: concepts, applications and potential.

As digital imaging and computing power increasingly develop, so too does the potential to use these technologies in ophthalmology. Image processing, analysis and computer vision techniques are increasing in prominence in all fields of medical science, and are especially pertinent to modern ophthalmology, as it is heavily dependent on visually oriented signs. The retinal microvasculature is unique in that it is the only part of the human circulation that can be directly visualised non-invasively in vivo, readily photographed and subject to digital image analysis.

The reengineering of a software system for glaucoma analysis.

Glaucoma is a destructive eye disease that causes blindness in individuals displaying little or no symptoms. There is no cure as yet though there are treatments that can arrest its effects or slow its development. The earlier the disease is detected, the more likely the treatment will be successful; however early detection of the disease can be difficult.

Online eye care in prisons in Western Australia.

In prisons, prison medical officers provide general medical care. However, if specialist care is needed then the prisoner is transported to a specialist medical centre. This is a costly procedure and prison escapes occur during transportation.

Neuroretinal rim measurement error using PC-based stereo software.

The neuroretinal rims of a set of glaucoma patients were measured using digitized stereo photographs, to determine the reproducibility of computerized stereo measurements of the neuroretinal rim. Each rim was measured five times at 18 locations, with measurement error (ME) defined as the mean of standard deviations of each set of measurements. The following ME were determined: (i) inter-sessional variability (n = 27 right and 24 left eyes, at t1 and t2); (ii) inter-assessor variability (n = 9, 2 assessors); and (iii) variability after colour adjustment algorithms were applied (n = 15).

Fred Hollows lecture: digital screening for eye disease.

The purpose of this study was to explore progress, in the adaptation to community screening for blinding eye disease, of digital imaging devices and technology for storage and transmission. Available imaging systems were compared to gold standard clinical photography in terms of sensitivity and specificity for diagnosis of common blinding eye conditions. Since the use of expensive non-portable imaging devices is likely to be limited for widespread community screening purposes, a portable fundus camera (Nidek, Chiyoda-ku, Japan) and a prototype monocular digital indirect ophthalmoscope constructed at the Lions Eye Institute (LEI) were selected for comparative trials for the screening of optic disc cupping, glaucoma and clinical signs of diabetic retinopathy.

Telemedicine screening of diabetic retinopathy using a hand-held fundus camera.

The objective was to evaluate digital images of the retina from a handheld fundus camera (Nidek NM-100) for suitability in telemedicine screening of diabetic retinopathy. A handheld fundus camera (Nidek) and a standard fundus camera (Zeiss) were used to photograph 49 eyes from 25 consecutive patients attending our diabetic clinic. One patient had cataracts, making it impossible to get a quality image of one of the eyes (retina).

Methods and limits of digital image compression of retinal images for telemedicine.

Purpose: To investigate image compression of digital retinal images and the effect of various levels of compression on the quality of the images.

Methods: JPEG (Joint Photographic Experts Group) and Wavelet image compression techniques were applied in five different levels to 11 eyes with subtle retinal abnormalities and to 4 normal eyes. Image quality was assessed by four different methods: calculation of the root mean square (RMS) error between the original and compressed image, determining the level of arteriole branching, identification of retinal abnormalities by experienced observers, and a subjective assessment of overall image quality.

International transmission of tele-ophthalmology images.

Tele-ophthalmic consultations were conducted between a hospital in East Java, Indonesia, and an ophthalmology centre in Perth, Western Australia. Twenty-two eyes of 14 subjects were screened for glaucoma using a hand-held fundus camera. Optic disc images comprised 267 x 234 pixels at 24 bit/pixel (187 kByte).