Mobile Teleophthalmology Camp Workflow at Sankara Nethralaya

Mobile Teleophthalmology Camp

As an eye care institution Sankara Nethralaya believes strongly in conducting comprehensive eye examinations and not quick, cursory check-ups. This holistic approach is evident in its outdoor eye examination camps as the following description would indicate

The “social worker-planning is a key resource at every Tele-ophthalmology camp, he ensures a high level of awareness about the camp to be conducted and optimum attendance by the locals. His responsibilities include guiding the sponsors/organizers on generating adequate publicity through (Thandora, Handbills, Banners, Auto announcements, Posters, Cable TV, Cinema slides, Wall Writing etc) to the surrounding community. The social worker will visit the campsite one week before the scheduled date of the camp to oversee the arrangements and discuss the strategies to ensure smooth functioning of the eye camp with the sponsors/organizers.

Teleophthalmology Workflow

Awareness Meeting

Short films are screened at the campsite to spread awareness on eye donation, eye care, eye health among waiting patients and their attenders. A film on Eye Donation, starring Super Star Rajinikanth, a film on Diabetic Retinopathy starring Shri SubbuArumugam, Villu Pattu Artist are some of the popular films screened, these films also educate the audience on primary eye care, Refractive error, awareness of spectacle use, Cataract, Glaucoma, Diabetic Retinopathy etc. All through the program, our optometrists and social workers are available to clarify doubts and answer any queries that the audience may have.

Patient Registration

The patient's personal info including name, age and address, occupational, sources of income are recorded in the Electronic Medical Records (EMR). Camp patients are then issued with identity cards. The second level of detailed eye examination includes updating the patient’s eye /vision status and other past & present history in the Electronic Medical Records with the help of Laptops, at the camp site.

Vision Check

Patients who are registered undergo comprehensive eye examination by the optometrists. Vision charts such as the Snellen drum are used for examination at the Out Reach Camps. Charts in the local language for patients not familiar with English and sign charts for the unlettered are used to facilitate easy eye power check.

Refraction

A majority of vision issues certain to refractive errors which can be reversed by simply wearing a pair of spectacles. Refraction refers to examining the patient’s eye in order to determine whether the patient’s vision can be corrected just by making him/her wear a pair of spectacles with the exact power. Optometrists from Sankara Nethralaya carry out this key process at the camp site.

Slit Lamp Examination

A slit lamp examination is also carried out at the camp site in order to rule out any disorder of the anterior segment.

Intra Ocular Pressure (IOP)

IOP of all patients are recorded and entered in the EMR. Patients with abnormal pressure and changes in the optic disc are referred to the base hospital. High IOP is a dangerous and if left unchecked can lead to glaucoma which is an irreversible and blindness of visual impairment.

Fundus Examination

Teleophthalmology Fundus Camera

Non Mydriatic fundus camera is used to capture the retinal images of patients without subjecting the same to dilatation. The entire process usually takes approximately five to ten minutes. Patients identified with any kind of abnormal retinal pathology are referred to the base hospital.

Teleophthalmology–Indirect Ophthalmoscope

By ophthalmologist (Only in specified cases) Teleconsultation forms the next level of examination where our ophthalmologist from the central hub at the base hospital holds a Teleconsultation with patients at the campsite.

Teleophthalmology Consultation

The patient’s preliminary eye examination reports (EMR) along with images taken with the help of the Non mydriatric Fundus camera are transferred to Sankara Nethralaya-Central Hub. Teleconsultation is a video conference involving the patient and Optometrist at the campsite and the consultant ophthalmologist at the base hospital .The patient's problem is discussed in great detail and the ophthalmologist makes the final diagnosis before treating the patient.

Glass Sales Counter

The counter facilitates the dispensing of scientifically tested, quality spectacles to patients who are prescribed glasses at the campsite. This is done either totally cost free or on a ‘at cost’ basis.

Counseling

Patients and their attendants are counseled on the basics of eye care, the nature of their ailment etc, eligibility criteria for free treatment/surgery is also explained to the patients at the campsite. Patients needing Medical/surgical care are advised to visit the Jaslok Community Care Center (JCOC), for free treatment.

Central Hub – Procedure

Selected patients have their anterior segment and non-mydriatic fundus photos taken. Retina of patients who have squint or other extra ocular problems are also photographed. Telecommunication between the rural camp and Sankara Nethralaya, Chennai is established using Laptop with Internet connectivity through Data card / Hot spot which has a bandwidth of 2Mbps

Campsite

Central Hub

A senior ophthalmologist at Sankara Nethralaya, Chennai examines the images and EMR received and comes to a provisional diagnosis. An anterior segment video may be requested in specific Cases . Demonstration of extra procedures like eye movements may also be requested. The ophthalmologist maintains electronic medical records of all the patients, segregates interesting cases, maintains a file for discussion with peers or seniors and is involved in the training of fellow ophthalmologists, optometrists, and social workers in rural and semi-urban areas. During the course of the teleconsultation, the ophthalmologist counsels the patient about the medical and surgical treatment of the ocular disease and preventive aspects of eye care.