Teleretinal Laser Photocoagulation- Novel paradigm to treat Diabetic Retinopathy at a distance: JAMA

The reliability of teleophthalmology-based evaluation and screening approaches have been demonstrated in multiple studies to date. Several programs focused on the treatment of diabetic retinopathy (DR) have successfully implemented teleophthalmology approaches.

Telephotocoagulation treatment with real-time online monitoring techniques is a much safer medical approach than offline telemedicine. The development of fifth-generation (5G) wireless systems has the potential to revolutionize telemedicine as a means of treating DR, making it feasible to deliver real-time health care–related services from a distance to remote patients. During the COVID-19 pandemic, the ability to conduct telemedicine in collaboration with local ophthalmologists to monitor and treat DR has become increasingly crucial.

The development of laser photocoagulation instruments and new telecommunication platforms have highlighted the promise of therapeutic telemedicine as a means of treating DR.

Huan Chen and team conducted teleophthalmology interventions for patients with DR using a 5G-based teleconsultation platform and a real-time automated retinal laser device. The primary goal of this study was to assess the feasibility of real-time telephotocoagulation treatment for DR. The secondary goal of this study was to investigate a potential health care solution for patients under adverse circumstances, as in the context of the COVID-19 pandemic, which has limited the ability of patients to travel for health care.

This was a prospective study involving a retinal specialist from the Peking Union Medical College Hospital in Beijing, China, who performed online 5G real-time navigated retinal laser photocoagulation to treat participants with proliferative or severe nonproliferative DR who had been recruited in the Huzhou First People's Hospital in Zhejiang Province, China, from October 2019 to July 2020. These teleretinal DR and laser management procedures were conducted using a teleophthalmology platform that used the videoconference platform for teleconsultation, after which telelaser planning and intervention were conducted with a laser system and a platform for remote computer control, which were connected via 5G networks. Diabetic eye prognosis and the real-time laser therapy transmission speed were evaluated.

The retinal specialist planned individual patient treatment approaches by swiping with his finger to define laser areas and caution zones (nonlaser areas) on a color fundus photograph presented on the telemedicine platform screen, after which the laser system performed photocoagulation automatically based on this treatment plan. Throughout this process, the retinal specialist monitored the laser effect via videoconferencing to ensure safety and real-time synchronization.

RESULTS:

• Six eyes underwent panretinal photocoagulation (PRP), 1 eye underwent focal/grid photocoagulation, and 2 eyes underwent both PRP and focal/grid photocoagulation.

• The mean (SD) age was 53.7 (13.6) years (range, 32-67 years). The mean (SD) duration of diabetes was 14.3 (6.4) years (range, 3-20 years). The mean (SD) logMAR at baseline was 0.32 (0.20) (20/30 Snellen equivalent).

• Retinal telephotocoagulation operations were performed on all eyes without any noticeable delay during treatment. The mean (SD) number of panretinal photocoagulation laser spots per eye in 1 session was 913 (243).

• All medical records were sent from Huzhou to Beijing for treatment planning, and all treatment plans were successfully transmitted without any errors. The mean (SD) data upload and download speeds were 88.45 (5.39) MB/s and 853.63 (52.71) MB/s, respectively, with no loss of signal quality.

• The mean (SD) video call time was 23.4 (5.6) minutes, including 3.5 (1.1) minutes for treatment planning and 18.1 (5.2) minutes per eye for automatic laser application.

The advent of new technologies and devices that can be used to remotely manage certain diseases has led to telemedicine emerging as a valuable tool for providing quality care to patients at a distance. The development of digital automated laser devices and 5G networks has made real-time telephotocoagulation for the treatment of fundus diseases an ideal telemedicine strategy.

The present study represents an important step in this direction for the ophthalmology field, as authors were able to successfully implement a continuous remote laser treatment in some patients, and no patients included herein experienced any deterioration with respect to DR stage or classification.

The novel technologies used in the present study can be leveraged to educate local ophthalmologists regarding the retinal laser photocoagulation procedure, in addition to improving patient access to services and lowering associated health care costs. Using imaging devices and high-speed network transmission to visualize lesions in real time can enable less experienced ophthalmologists to learn the retinal laser photocoagulation approach in an intuitive manner during the telemedicine process, in contrast to traditional telemedicine.

In summary, authors herein outlined a novel telemedicine paradigm that uses multiple tools and techniques, including a 5G high-speed network, navigated retinal laser photocoagulation, videoconferencing, and real-time monitoring to treat DR via laser photocoagulation therapy. This strategy may help overcome limitations to health care access and medical inequality in nations with limited health care resources. As digital technologies continue to evolve, current barriers to health care access will be overcome such that more individuals will be able to obtain quality care.

Source: JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2021.2312