Teleophthalmology Support for Primary Care Diagnosis and Management

Abstract This study was performed to evaluate a healthcare strategy based on teleophthalmology for diagnosis and management of primary healthcare users. A descriptive cross-sectional study was conducted to review the medical records of patients from January ۲۰۱۳ to December ۲۰۱۴ from primary care units in the city of São Paulo. The units referred patients, who had diabetes or high blood pressure, and were users of chloroquine compounds, for a fundus examination. The images were sent to a reading center for review, diagnosis, and patient referrals. From ۹۱۷۳ analyzed patients, ۵۷۰ (۶.۲%) were excluded because of poor image quality. Of the remaining patients, ۴۹۳۳ (۵۷.۳%) had diabetes, ۷۲۴۲ (۸۴,۲%) systemic hypertension, and ۱۱۳ (۱.۳%) used chloroquine. Of these, ۹۸۹ (۱۱.۵%) patients needed ophthalmologic treatment. The most frequently prescribed treatments were cataract extraction in ۶۹۲ (۷۰%) of ۹۸۹ and photocoagulation in ۲۴۵ (۲۴.۸%) of ۹۸۹ cases. Overall, cataract extraction was indicated in ۶۹۲ (۸%) of ۸۶۰۳ cases and photocoagulation in ۲۴۵ (۲.۸%) of ۸۶۰۳ cases. When only patients with diabetes were considered, the indication for photocoagulation increased to ۴.۵%.The results showed that non-medical professionals could produce good-quality ocular images for screening of ocular diseases in most cases; only ۶.۲% of ocular images did not meet quality requirements. Most patients referred for fundus examination did not need a specific treatment, indicating that this system could be an inexpensive and reliable tool for use in developing countries.Â