While numerous investigations have explored using telemedicine for screening and monitoring diabetic retinopathy, treatments delivered remotely remain uncommon. Now, with the advent of fifth-generation (5G) technology, researchers are investigating the feasibility of real-time telephotocoagulation treatments. The study, published in JAMA Ophthalmology, shows how the high-speed network could potentially bring treatments to patients in rural and remote locations and expand ophthalmology’s reach.
Six patients with severe proliferative DR (PDR) (3 patients, 5 eyes) or nonproliferative DR (3 patients, 4 eyes) underwent eye exams prior to retinal laser photocoagulation treatment. A retinal specialist discussed conditions and treatments with the patients and local ophthalmologists using videoconferencing technology and remotely controlled the laser using a computer. The retinal specialist received video transmission of the operation interface, fundus (in real-time), the laser treatment room, and the digital laser device monitor and guided the laser system to perform the photocoagulation.
Six eyes underwent panretinal photocoagulation (PRP), 1 eye underwent focal/grid photocoagulation, and 2 eyes underwent both treatments. All treatments were successful. No adverse events occurred during the procedures.
At 1 month follow-up, 4 patients (7 eyes) had not experienced significant changes in visual acuity, and 2 patients (2 eyes) had to postpone follow-up until 6 months. By 6 months, the 2 patients who experienced delays in follow-up due to COVID-19 had experienced decreases in visual acuity and poor glucose control, and 1 of them underwent cataract surgery. Two eyes in 1 patient experienced persistent neovascularization at 1 month after the procedure and required PRP.
“Not all patients achieved satisfactory short-term outcomes in this study, potentially owing to the inherent limitations of navigated laser treatment,” the report explains. “However, owing to restrictions associated with local economic factors and national medical insurance, most rural Chinese patients are unable to access regular comprehensive treatments that are in accordance with current practice guidelines. As such, multiple medical disciplines must cooperate with one another to facilitate comprehensive remote telemedicine for these patients.”
However, the treatment plans themselves were successfully transmitted without loss of signal quality, significant signal loss, any observed image buffering or pixilation, or complications. Mean data upload speed was 8.45 MB/s, and mean download speed was 853.63 MB/s. Mean network latency time was 20 milliseconds. The mean video call time was 23.4 (SD 5.6) minutes, which included 3.5 (SD: 1.1) minutes for treatment planning and 18.1 (SD: 5.2) minutes per eye for automatic laser application.
Limitations of the teleophthalmology procedure include costs, access to technology, and legal constraints. A randomized clinical trial would be required to show whether the procedure impacts vision outcomes and its risk of complications.
Chen H, Pan X, Yang J, et al. Application of 5G technology to conduct real-time teleretinal laser photocoagulation for the treatment of diabetic retinopathy. JAMA Ophthalmol. Published online July 8, 2021. doi:10.1001/jamaophthalmol.2021.2312