<s>
Teleophthalmology	B-Application
is	O
a	O
branch	O
of	O
telemedicine	B-Application
that	O
delivers	O
eye	O
care	O
through	O
digital	O
medical	O
equipment	O
and	O
telecommunications	O
technology	O
.	O
</s>
<s>
Today	O
,	O
applications	O
of	O
teleophthalmology	B-Application
encompass	O
access	O
to	O
eye	O
specialists	O
for	O
patients	O
in	O
remote	O
areas	O
,	O
ophthalmic	O
disease	O
screening	O
,	O
diagnosis	O
and	O
monitoring	O
;	O
as	O
well	O
as	O
distant	O
learning	O
.	O
</s>
<s>
Teleophthalmology	B-Application
enables	O
health	O
professionals	O
to	O
take	O
ocular	O
images	O
and	O
attend	O
to	O
patients	O
who	O
have	O
limited	O
access	O
to	O
ocular	O
health	O
care	O
.	O
</s>
<s>
There	O
has	O
been	O
a	O
significant	O
increase	O
in	O
teleophthalmology	B-Application
research	O
over	O
the	O
past	O
decade	O
.	O
</s>
<s>
However	O
,	O
differences	O
in	O
health	O
information	O
exchange	O
standards	O
,	O
data	O
security	O
,	O
liability	O
issues	O
,	O
and	O
cost	O
of	O
equipment	O
are	O
other	O
major	O
challenges	O
in	O
teleophthalmology	B-Application
.	O
</s>
<s>
Technological	O
advancements	O
in	O
digital	O
ocular	O
imaging	O
devices	O
are	O
perceived	O
by	O
many	O
as	O
key	O
drivers	O
for	O
teleophthalmology	B-Application
.	O
</s>
<s>
Recently	O
,	O
emerging	O
retinal	O
imaging	O
modalities	O
such	O
as	O
optical	B-Application
coherence	I-Application
tomography	I-Application
are	O
capable	O
of	O
producing	O
digital	O
images	O
of	O
the	O
retina	O
with	O
a	O
micrometer	O
resolution	O
,	O
which	O
can	O
be	O
transmitted	O
for	O
research	O
or	O
diagnostic	O
purposes	O
.	O
</s>
<s>
Teleophthalmology	B-Application
services	O
can	O
be	O
provided	O
primarily	O
in	O
two	O
ways	O
synchronously	O
or	O
asynchronously	O
:	O
</s>
<s>
Synchronous	O
teleophthalmology	B-Application
enables	O
real-time	O
interaction	O
between	O
participants	O
(	O
using	O
standard	O
telemedicine	B-Application
technologies	O
e.g.	O
</s>
<s>
Asynchronous	O
teleophthalmology	B-Application
in	O
a	O
"	O
store-and-forward	O
"	O
method	O
,	O
where	O
data	O
is	O
captured	O
and	O
transmitted	O
for	O
review	O
at	O
a	O
later	O
time	O
.	O
</s>
<s>
Between	O
image	O
capture	O
and	O
viewing	O
,	O
image	O
processing	O
may	O
be	O
done	O
,	O
including	O
compression	B-General_Concept
,	O
enhancement	O
and	O
edge-detection	B-Algorithm
.	O
</s>
<s>
Dedicated	O
research	O
in	O
artificial	B-Application
intelligence	I-Application
drives	O
the	O
underlying	O
technology	O
in	O
automated	O
image	O
recognition	O
.	O
</s>
<s>
Specific	O
approaches	O
involve	O
pattern	O
recognition	O
using	O
trained	O
artificial	B-Architecture
neural	I-Architecture
networks	I-Architecture
;	O
feature	O
extraction	O
using	O
edge-detection	B-Algorithm
and	O
region-growing	B-Algorithm
techniques	O
;	O
and	O
content-based	O
comparison	O
with	O
previously	O
adjudicated	O
samples	O
.	O
</s>
<s>
A	O
number	O
of	O
teleophthalmology	B-Application
programs	O
exist	O
in	O
Canada	O
,	O
including	O
those	O
in	O
the	O
provinces	O
of	O
Alberta	B-Protocol
,	O
British	O
Columbia	O
,	O
Manitoba	O
,	O
Newfoundland	O
,	O
Ontario	B-Architecture
,	O
and	O
Quebec	O
.	O
</s>
<s>
Key	O
challenges	O
to	O
providing	O
teleophthalmology	B-Application
services	O
in	O
Canada	O
are	O
likely	O
:	O
1	O
)	O
the	O
high	O
staff	O
turnover	O
in	O
remote	O
areas	O
;	O
2	O
)	O
the	O
lack	O
of	O
an	O
inexpensive	O
mobile	O
imaging	O
device	O
that	O
takes	O
diagnostic	O
quality	O
images	O
;	O
and	O
3	O
)	O
the	O
difficulty	O
securing	O
public	O
funds	O
where	O
the	O
costs	O
are	O
incurred	O
and	O
savings	O
are	O
realized	O
from	O
separate	O
funding	O
envelopes	O
.	O
</s>
<s>
Teleophthalmology	B-Application
has	O
been	O
provided	O
in	O
Alberta	B-Protocol
since	O
2003	O
,	O
and	O
is	O
supported	O
by	O
Alberta	B-Protocol
Health	O
Services	O
,	O
using	O
their	O
proprietary	O
teleophthalmology	B-Application
software	O
.	O
</s>
<s>
Approximately	O
six	O
ophthalmologists	O
from	O
the	O
University	O
of	O
Alberta	B-Protocol
review	O
the	O
images	O
.	O
</s>
<s>
The	O
teleophthalmology	B-Application
program	O
also	O
facilitates	O
approximately	O
55	O
optometrist-to-ophthalmologist	O
referrals	O
per	O
month	O
.	O
</s>
<s>
Teleophthalmology	B-Application
is	O
provided	O
by	O
ophthalmologists	O
from	O
the	O
University	O
of	O
British	O
Columbia	O
,	O
and	O
is	O
supported	O
by	O
Alberta	B-Protocol
Health	O
Service	O
's	O
proprietary	O
software	O
.	O
</s>
<s>
In	O
Manitoba	O
,	O
teleophthalmology	B-Application
is	O
provided	O
by	O
ophthalmologists	O
at	O
the	O
University	O
of	O
Manitoba	O
,	O
and	O
is	O
supported	O
using	O
Alberta	B-Protocol
Health	O
Service	O
's	O
proprietary	O
software	O
.	O
</s>
<s>
A	O
teleophthalmology	B-Application
program	O
was	O
started	O
in	O
the	O
Eastern	O
Health	O
Region	O
of	O
Newfoundland	O
,	O
under	O
one	O
of	O
four	O
regional	O
health	O
authorities	O
.	O
</s>
<s>
Thirteen	O
teleophthalmology	B-Application
programs	O
currently	O
exist	O
in	O
Ontario	B-Architecture
.	O
</s>
<s>
The	O
other	O
eleven	O
of	O
these	O
teleophthalmology	B-Application
programs	O
primarily	O
screen	O
for	O
diabetic	O
retinopathy	O
in	O
diabetic	O
patients	O
who	O
have	O
limited	O
access	O
to	O
eye	O
care	O
professionals	O
,	O
or	O
who	O
for	O
various	O
reasons	O
do	O
not	O
seek	O
regular	O
eye	O
care	O
.	O
</s>
<s>
OTN	O
uses	O
teleophthalmology	B-Application
software	O
to	O
provide	O
this	O
service	O
.	O
</s>
<s>
Some	O
of	O
these	O
locations	O
use	O
a	O
fundus	O
camera	O
,	O
others	O
use	O
both	O
fundus	O
and	O
optical	B-Application
coherence	I-Application
tomography	I-Application
(	O
OCT	O
)	O
imaging	O
devices	O
,	O
and	O
all	O
programs	O
dilate	O
their	O
patients	O
 '	O
eyes	O
before	O
screening	O
.	O
</s>
<s>
In	O
Ontario	B-Architecture
,	O
the	O
implementation	O
of	O
teleophthalmology	B-Application
has	O
reduced	O
the	O
average	O
wait	O
time	O
from	O
six	O
months	O
to	O
four	O
weeks	O
,	O
for	O
some	O
diabetic	O
patients	O
to	O
obtain	O
retinal	O
screening	O
from	O
a	O
specialist	O
.	O
</s>
<s>
There	O
are	O
a	O
number	O
of	O
teleophthalmology	B-Application
programs	O
in	O
Quebec	O
,	O
following	O
on	O
a	O
feasibility	O
study	O
completed	O
by	O
the	O
,	O
entitled	O
.	O
</s>
<s>
The	O
teleophthalmology	B-Application
program	O
provided	O
in	O
Chennai	O
,	O
India	O
by	O
has	O
reached	O
more	O
than	O
450,000	O
patients	O
since	O
its	O
inception	O
in	O
October	O
,	O
2003	O
.	O
</s>
<s>
The	O
,	O
started	O
in	O
2008	O
,	O
uses	O
teleophthalmology	B-Application
to	O
screen	O
for	O
retinopathy	O
of	O
prematurity	O
.	O
</s>
<s>
A	O
pilot	O
project	O
with	O
telemedicine	B-Application
transmission	O
of	O
retinal	O
OCT	O
images	O
from	O
community	O
optometry	O
care	O
to	O
hospital	O
eye	O
services	O
improved	O
the	O
triage	O
of	O
macular	O
patients	O
and	O
swifter	O
care	O
of	O
urgent	O
cases	O
.	O
</s>
<s>
In	O
Scotland	O
,	O
NHS	O
Forth	O
Valley	O
has	O
introduced	O
teleophthalmology	B-Application
in	O
standard	O
practice	O
,	O
to	O
link	O
ophthalmologists	O
and	O
emergency	O
services	O
.	O
</s>
<s>
Teleophthalmology	B-Application
relies	O
on	O
a	O
standard	O
for	O
the	O
representation	O
,	O
storage	O
,	O
and	O
transmission	O
of	O
medical	O
images	O
known	O
as	O
Digital	B-Algorithm
Imaging	I-Algorithm
and	I-Algorithm
Communications	I-Algorithm
in	I-Algorithm
Medicine	I-Algorithm
(	O
DICOM	B-Algorithm
)	O
.	O
</s>
<s>
USA	O
-	O
Health	O
Insurance	O
Portability	O
and	O
Accountability	O
Act	O
-	O
licensure	O
laws	O
in	O
the	O
U.S.	O
require	O
a	O
practitioner	O
to	O
obtain	O
a	O
full	O
license	O
to	O
deliver	O
telemedicine	B-Application
care	O
across	O
state	O
lines	O
where	O
regulations	O
vary	O
.	O
</s>
<s>
Teleophthalmology	B-Application
has	O
the	O
potential	O
to	O
improve	O
access	O
to	O
screening	O
and	O
early	O
treatment	O
for	O
a	O
number	O
of	O
ocular	O
conditions	O
.	O
</s>
<s>
As	O
such	O
,	O
teleophthalmology	B-Application
cannot	O
be	O
a	O
true	O
substitute	O
for	O
comprehensive	O
eye	O
examinations	O
using	O
traditional	O
binocular	O
observation	O
with	O
standard	O
7-field	O
stereoscopic	O
fundus	O
photography	O
.	O
</s>
