Tele-Eye Care and Eye Disease Risk Prediction Prof K Yogesan (Yogi)
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1 Tele-Eye Care and Eye Disease Risk Prediction Prof K Yogesan (Yogi) Australian of the Year in WA Finalist Research Director, Australian E-Health Research Centre Visiting Scholar, Harvard University Professor, School of Medicine, Univ. of Notre Dame
2 2016
3 70 Staff from Brisbane, Perth, Sydney, Melbourne Committed to high quality, applied research that aims to improve the quality and safety of health care for individuals and communities 12 Staff in WA funded by WA Health, CSIRO and Industry Telemedicine and Mobile Health, Ophthalmic/ Eye related research
4 WA AEHRC Funded by WA Health and CSIRO Translational Research Remote Delivery of Clinical Services Chronic Disease Management Disease Screening Technologies
5 Alzheimer s Disease Through the EYE Eye test for early detection of Alzheimer s years before diagnosis World First Test to non-invasively detect Alzheimer s earlier and more cost-effectively than current alternatives
6 Remote Medical Services Ophthalmology Emergency Medicine ENT Dermatology Burns Dental
7 Tele-EyeCare (Started in WA in 1999)
8 Project Stakeholders Department of Health WA Health/ WA Country Health Service Australian Society of Ophthalmologists: Indigenous Remote Eye Service (IRIS) Queensland Health: Torres Strait-Northern Peninsula Hospital & Health Service
9 Project Objectives Connect ophthalmologists to patients with eye conditions in rural and remote Western Australia and Queensland Goal: Demonstrate a sustainable delivery and business model to continue service provision after the trial happened on 15 th March 2016 Secondary objectives: More efficient use of Ophthalmology resources A model that could be expanded to other medical specialties and services. Use computer-aided grading of images for diabetic retinopathy disease (mild, moderate or severe) / no disease
10 Main Focus - Diabetic Related Eye Disease Diabetic retinopathy (DR) a microvascular complication of diabetes, causing abnormalities in the retina, or blindness in the worst case.
11 Diabetics and Eye Disease 280 Australians develop diabetes every day (Diabetes Australia) In 2030, the prevalence of diabetes will be 1.67 millions in Australia and 336 millions worldwide WHO 30% of people with diabetes develop diabetic retinopathy cost US$ 493 million in USA [1] DR is a treatable blinding eye disease if detected early It will reduce the cost related to the blindness due to DR Regular eye examination not viable - lack of ophthalmologists 1) Rein,DB, Zhang,P, Wirth,KE et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol. 2006;124:
12 DR grading Color fundus image with DR signs Normal Mild Moderate Severe
13 Trial Locations with Satellite Dishes Torres Strait Islands Goldfields & Great Southern Laverton, Leonora Norseman, Ravensthorpe
14 Tele-eye Care Delivery Model Tele-eye care server Patient & health worker at remote location Videoconferencing for trauma, urgent & complex cases Phase 2: local server for automated DR grading Clinical decision support Store & forward image reading for routine cases City-based Ophthalmologist
15 One Fundus image/eye of Field of View 60 degrees and macula centered If not clear image then obtain Red-reflex image for cataract Visual acuity Clinical Protocol
16 Workforce Training Training in WA: Local workers are switched on and keen on participation
17 Award Winning REMOTE-I System: Video Conferencing/ Store & Forward / Mobile Platform
18 Features Store-and-forward system Video conferencing enabled Data archiving to EHR FHIR, (HL7), DICOM etc. Medical terminology to support thousands of drugs Support Mobile technology for image viewing, SMS Interoperable with multiple cameras Multiple medical applications Ear, Skin, Dental
19 Automated Image Quality Assessment Good Quality Not gradable (Need to take another image)
20 Medicines Terminology
21 21 NBN-Enabled TeleEyeCare Justin Boyle
22 Outcomes We exceeded the target numbers 1088 (>900 patients) In WA 800 patients screened In QLD 288 patients screened 344 of them are Aboriginal people 82 cases with diabetic retinopathy (10%) and 8 of them with severe or sight threatening DR If this kind of service is not available some of them would have gone blind
23 Cost benefit Satellite Tele-EyeCare Preliminary cost benefit analysis In WA $28,000/ month/ clinic savings In QLD $22,000/ month/ clinic savings
24 Broadband Satellite Speed/ Performance Testing
25 Success of the Work WACHS started eye service 15 th March 2016
26 Tele-Eye Care for Metro - Perth Eye testing for diabetic patients Royal Perth Hospital sends all diabetes to one locations for eye testing REACH clinic We provided entire telemedicine system for (REMOTE-I) Data Capture Data Transmission Data analysis Data Archiving for future visits and comparing disease progression
27 Cloud Based Disease Risk Prediction Diabetic retinopathy for mass screening Age Related Macular Degeneration
28 NHMRC Development Grant in 2015 Automated Diabetic Retinopathy Grading DR.Grader 1. Automatic DR features detection 2. Automatic summary report generation 3. Evaluate the report according to DR severity scales 3. Generate DR grading report Summary report MAs Less MAs (4 MAs) Less HMs (19 HMs; in each quadrant, the number of HMs < 20) DR level Moderate NPDR Detected MAs (green contours) HMs 2 EDs in macular center 12 EDs in macular 2DD region DME level Severe DME EDs Detected HMs (green contours) Detected EDs (green contours) Information of MAs, HMs, and EDs in 4 quadrants and 3 macular regions. American Academy of Ophthalmology (AAO) NHMRC, Australia International clinical diabetic retinopathy disease severity scale International clinical diabetic macular edema disease severity scale
29 Tele-Eye Care in China
30 Chinese Version of Remote-I
31 Remote-I at ZOC Guangdong China Supported by World Diabetes Foundation
32 10,000 patients gone through Remote-I in 1 year 660 patients needed lasers
33 Thank you Yogi - kan063@csiro.au
34
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