Telemedicine

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Telemedicine

• Definition
• The practice of medicine at a distance

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A successful telemedicine program often starts
with a face to face meeting
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ThenORBIS Telemedicine, Cyber-Sight
Provides low cost extended presence connecting
doctors on a continuous basis
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Cyber-Sight
How does it work?
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The Server
sends consult
receives consult
P
M
Located at Flight Safety, Flushing, NY
receives answer
sends answer
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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

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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

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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.

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The patients clinical condition is documented
with a digital camera
The camera should be set at 640x480, PC or TV to
obtain smallest picture
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Partner logs on to web site

• Go to www.orbis.org
• 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

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Partner sees this screen and is greeted by name
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Partner Selects sub-specialty from drop down
menu
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Sub-specialty selected
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Strabismus format
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Pictures have been uploaded
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Partner submits this information
I know the child needs glasses, patching, and
surgery. How would this be done best?
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?
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The mentor sees the patient information,
pictures, diagnosis, plan, and questions
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The mentor Answers
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A dialogue continues until The partner closes the
case
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Cyber-Sight

• Some examples of consultations

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Mentor diagnosisBrown OS
Partner diagnosis Double elevator palsy
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Partner diagnosis Duane Type III
Mentor diagnosisDuane Type II
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Mentor suggestionSimultaneous abduction Duane
IV
Partner diagnosis Left eye fibrous tissue
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Partner diagnosisBlowout fracture postop, recess
RSR
Mentor advisesForced ductions, likely need to
free RIR
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Subconjunctival hemorrhage Partner and mentor
agree
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Partner and mentor agree Conjunctival laceration
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Mentor Unilateral hypoplasia of the optic nerve
Partner Amblyopia?
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Partner Corneal dermoid
Mentor Agree corneal dermoid
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Partner What is it?
Mentor Epithelial implantation cyst
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Partner What is it?
Mentor Granular dystrophy
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Partner and Mentor agree Traumatic cataract
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Partner Corneal foreign body
Mentor Agree treat rust ring
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Partner Intraocular tumor what is it?
Mentor Retinal angioma
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Partner Retinal angioma
Mentor Agree retinal angioma
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Partner Foveal cyst
MentorIdiopathic retinal epithelial detachment
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Partner Retinoschisis
MentorTraction detachment
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Three unusual and instructive cases
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Mentor I agree LSO palsy could the left SO
tendon be missing?
Partner diagnosisLSO palsy
39
Absent muscle
Absent trochlea
Partner What about the tendon?
Mentor The left superior oblique tendon complex
is absent or severely atrophic
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Partner diagnosis Congenital RSO palsy, 3
surgeries, what next?
Mentor suggestionCT for presence of RSO
Trochlea present
Muscle absent
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I see two trochleas
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Partner points out absence of RSO muscle belly
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(No Transcript)
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Partner demonstrates traction test normal OD,
lax OS
Partner finds Absent LSO tendon at exploration
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Two other parts of the

• Cyber-Sight Program

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E-Resource

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

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(No Transcript)
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E- Learning

• BCSC questions
• Student course activity log in
• CME opportunities

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BCSC and CME
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Cyber-Sight is ORBIS Telemedicine

• Full program initiated spring 2003
• 140 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

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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.

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Thank you.