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Description of the Telemedical Eye Examination System Talkingeyes®
Autoren: Georg Michelson (Erlangen)

Fig 1: General Medical History, Part I

Fig 2: General Medical History, Part II

Fig 3: Ocular Medical History

Fig 4: upload of images and videos

Fig 5: standardized procedure for the medical evaluation of the posterior pole
3 Operational Description and Medical Applications of the Telemedical Eye Examination Systems Talking

1. Procedure of Telemedical Eye Examination System Talkingeyes®: Digital retinal images of both eyes are taken with a 45° non-mydriatic colour fundus camera centred on the optic nerve head. Pupils are not dilated. After completing the medical interview selected clinical images of the anterior, the posterior segment of all modalities are uploaded in the electronic patient chart. After upload the telemedical evaluation is performed by an experienced eye specialist. Figures 1-4 depict the data entry formulas, Figure 4 the formula to upload images. All images and data are saved on a server using the web-based software MedStage. The medical evaluation of the clinical images and clinical data is done through a telemedical analysis. Each case is evaluated by an experienced ophthalmologist using a standardized protocol with defined clinical criteria. Figure 5 shows the standardized procedure for the medical evaluation of the posterior pole. The evaluation of the images is facilitated by the options to zoom the images and to examine them in different aspects (colour image, red-free image, and green channel image). All tele-ophthalmological evaluations are performed within 3 working days, in case of emergency within 2 hours. The medical report is available in html- or pdf-format to the medical doctor or by the patient using ID and a password. Figure 6 depicts the scheme of the complete procedure.



2. List of MEDICAL APPLICATIONS of the Telemedical Eye Examination System Talkingeyes®: The described technique can be employed for patients with
• diabetes
• arterial hypertension
• neurological diseases like Parkinson, Alzheimer, Multiple Sclerosis
• age related macular degeneration
• glaucoma

a. Diabetes:
Recommendation to examine the retina by Colour Photography and Optical Coherenence Tomography (OCT): International references suggest, that in every patient with diabetes the retina should be checked for diabetic retinopathy at least once per year. The sensitivity for detection of diabetic retinopathy, and diabetic macular edema by the telemedical retina check is similar or higher compared to a visit in a private practice performing a regular ophthalmoscopy with widening of pupil (LITERATURE 1). For detecting early macular edema an examination by OCT is necessary.

b. Arterial hypertension
Recommendation to examine retinal vessels by Colour Photography and Adaptive Optics: In arterial hypertension retinal vessels should be examined, (1) to check out the degree of hypertensive retinopathy, (2) to assess the risk for general microangiopathic changes, and (3) to quantify the wall-to-lumen-ratio as a marker for arteriolosclerosis. (LITERATURE 2-3).

c. Neurological Diseases (Parkinson, Alzheimer, Multiple Sclerosis)
Recommendation to examine the optic nerve by Colour Photography and OCT: In some important neurological diseases there is an increasing body of evidence that an examination of the optic nerve and retinal axons serves as an indicator for a general brain atrophy, when the presence and degree of (1) optic nerve atrophy and of degenerated retinal axons is assessed. (LITERATURE 4 ).

d. Age-related Macular Degeneration (AMD)
Recommendation to examine retina by Colour Photography and OCT: The definite diagnosis of AMD is performed by examination of the macula by OCT, (1) to check out detachment of the retinal pigment epithelium, and (2) to assess the thickness of the subretinal neovascularization membrane, both serving as diagnostic factors for definite diagnosis of AMD. (LITERATURE 5 ).

e. Glaucoma
Recommendation to examine the optic nerve head by Colour Photography and OCT: The definite diagnosis of open angle glaucoma is performed by an examination of the optic nerve head by Colour Photography and by OCT, (1) to check out the degree of retinal rim area loss, and (2) to assess the number of retinal axons, both serving as factor for definite diagnosis of open angle glaucoma. (LITERATURE 6 ).





Chapters
1 Medical Background




2 Technical Description of Important Aspects of the Telemedical Eye Examination Systems Talkingeyes®




3 Operational Description and Medical Applications of the Telemedical Eye Examination Systems Talking




4 Prevalence of Retinal Microangiopathic Abnormalities and Optic Nerve Atrophy in “Healthy” Subjects D




5 Contact




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