Telemedicine Definition : The practice of medicine at a distance

A successful telemedicine program often starts with a face to face meeting

Then…ORBIS Telemedicine, Cyber-Sight Provides low cost extended presence connecting doctors on a continuous basis

Cyber-Sight How does it work?

The Server information original links  Located at Flight Safety, Flushing, NY

E-Consultation As described in the previous slide offers partners the opportunity to obtain consultation on difficult patients from an expert with the added opportunity to interact during the evaluation process and to share results of treatment in these patients

The consultation process goes like this: The partner is identified, trained, assigned a password and user name, and when needed given a camera and computer The partner is assigned to a mentor team A challenging patient is photographed by the partner and the history and pictures of the case are uploaded and sent The mentor is alerted, answers the consult, and a dialogue is established The partner closes the case when it is completed

Mentor Teams are made up of experts in the following sub-specialties Cornea Retina Glaucoma Oculo-plastics Pediatric ophthalmology/strabismus Uveitis ROP Genetics Retinoblastoma Cataract Neuro-ophthalmology Etc.

The patient’s clinical condition is documented with a digital camera* *The camera should be set at 640x480, PC or TV to obtain smallest picture

Partner logs on to web site Go to: Click on Cyber-Sight (left side of screen scroll down ¼ screen) Click on Cyber-Sight again on right side of screen Click on E-consultation Add user name and password – these are assigned by ORBIS This brings up the formatted page for patient information upload

Partner sees this screen and is greeted by name

Partner Selects sub- specialty from “drop down” menu

Sub- specialty selected

Strabismus format

Pictures have been uploaded

Should I cut the plus? If so should I cut the same percentage in each eye? Is it possible that wearing glasses will result in alignment? What should I do first? I know the child needs glasses, patching, and surgery. How would this be done best? Partner submits this information

The mentor sees the patient information, pictures, diagnosis, plan, and questions

The mentor Answers

A dialogue continues until The partner closes the case

Cyber-Sight Some examples of consultations

Partner diagnosis: Double elevator palsy Mentor diagnosis: Brown OS

Partner diagnosis: Duane Type III Mentor diagnosis:Duane Type II

Partner diagnosis: Left eye fibrous tissue Mentor suggestion: Simultaneous abduction: Duane IV

Partner diagnosis:Blow out fracture postop, recess RSR Mentor advises:Forced ductions, likely need to free RIR

Subconjunctival hemorrhage: Partner and mentor agree

Partner and mentor agree: Conjunctival laceration

Mentor: Unilateral hypoplasia of the optic nerve Partner: Amblyopia? Note double ring sign of optic nerve hypoplasia

Partner: Corneal dermoid Mentor: Agree – corneal dermoid

Partner: What is it? Mentor: Epithelial implantation cyst

Partner: What is it? Mentor: Granular dystrophy

Partner and Mentor agree: Traumatic cataract

Partner: Corneal foreign body Mentor: Agree – treat rust ring

Partner: Intraocular tumor – what is it? Mentor: Retinal angioma

Partner: Retinal angioma Mentor: Agree – retinal angioma

Partner: Foveal cyst Mentor:Idiopathic retinal epithelial detachment

Partner: Retinoschisis Mentor:Traction detachment

Three unusual and instructive cases…

Partner diagnosis:LSO palsy Mentor: I agree – LSO palsy; could the left SO tendon be missing?

Partner: What about the tendon? Mentor: The left superior oblique tendon complex is absent or severely atrophic Absent muscle Absent trochlea

Partner diagnosis: Congenital RSO palsy, 3 surgeries, what next? Mentor suggestion:CT for presence of RSO Muscle absent Trochlea present

I see two trochleas

Partner points out absence of RSO muscle belly

Partner diagnosis: Brown OD vs. LSO palsy Mentor comment:Most likely Brown OD; LSO palsy a long shot; depends on traction test

Partner demonstrates traction test – normal OD, lax OS Partner finds Absent LSO tendon at exploration

Two other parts of the Cyber-Sight Program:

E-Resource Ophthalmology Minute Featured Cases Question of the week Decision Making in Strabismus Eye Pathologist (link)

E- Learning BCSC questions Student course activity log in CME opportunities

BCSC and CME

Cyber-Sight is ORBIS Telemedicine Full program initiated spring mentors 296 partners 68 sites 32 countries 135 mentors 40 answering consults W2,075 consults – 6,000 communications 1,372 strabismus / ped. ophth. 200 E-Learning students

The flow of consults is as follows: The partner is congratulated for having the right diagnosis and correct treatment plan. Or an alternate diagnosis and treatment plan is suggested. Additional workup is recommended. Teaching points and suggested additional reading are made.

Thank you.