Can We Get Our Minds Around Remote Eye and Vision Consultation?.

Last month, Optometry and Vision Science featured a Guest Editorial on primary eye care. It emphasized the broad scope of practice responsibilities of primary care rather than the emergence of novel treatments or legislated privileges associated with them. In that editorial, Doug Hopkins emphasized the importance of the optometrist in providing breadth of eye and vision care as a gatekeeper in the family practice tradition. In short, he urged a primary eye and vision care training and a professional mindset that anticipates all persons with a perceived eye or vision-related problem coming to an optometrist and expecting an appropriate treatment and management outcome. Furthermore, the overwhelming majority of those patients would actually receive the treatment from that optometrist, the remainder being referred appropriately and potentially comanaged.

In this month's Optometry and Vision Science, I have invited another Guest Editorial that challenges us to think of the possibilities of new and developing responsibilities both within that primary eye care role and as part of emerging specialties of optometry. This Guest Editorial, by Jorge Cuadros, sketches out new horizons for us in eye care, perhaps horizons few of us have envisioned.

Imagine patients in remote areas of our country or within general health settings having the opportunity for an online consultation with you for possible diabetes eye complications, glaucoma screening, anterior segment disorders, pediatric eye conditions, or retinal complication in macular degeneration that can account for vision loss. Such a scenario places our patient care in a broader context and intimately associated with an expanded range of healthcare settings. Imagine some of us being so involved with this telehealth context that practice consultation of this kind becomes a central part of the practice.

Technology has advanced not only our clinical imaging capabilities, but also our communication possibilities. The reality is that the technical obstacles for gathering high-quality photographic images for online consultation are not only a problem of the past, but that low-cost instruments and minimal training needed for the successful gathering of these images is on the horizon.

Optometry and ophthalmology have made advances in the many forms of what might be labeled “teleophthalmic,” part of telemedicine or telehealth consultation, providing some interesting “hands-on” examples of how well it can work. I expect that Optometry and Vision Science and other ophthalmic journals will increasingly reflect the outcomes of significant studies of the impact of medical informatics and telehealth on the provision of expanded eye and vision care for the public.

In this Guest Editorial, Jorge Cuadros, OD, PhD, very briefly outlines the paths that telemedicine and telehealth have already taken. Then, in his role as Director of Clinical Informatics Research at the UC Berkeley School of Optometry Clinical Research Center, he presents some examples of the most promising applications with which he has been directly involved. He developed, over a decade ago, the EyePacs system. It is now in use in a number of institutions across the country. Cuadros has emphasized the importance of the professional eye care provider in remote telehealth decision-making applications. Nevertheless, he keeps open the more technically challenging possibilities of automated decision-making based on machine image recognition now being developed experimentally and broadly across many medical fields, including in retinal and optic nerve head imaging.

Optometry needs to be alert to the potential to provide eye and vision care within new contexts and with new paradigms. We need to be alerted to possibilities that are beyond the horizon for most of us. We need to assure that we have the appropriate education and training within our schools. We also need the usual forward legislative thinking required of our state and national organizations for the successful optometric practice providing the best care for our patients.