title: The United States Army Ocular Teleconsultation program 2004 through 2009.
abstract: OBJECTIVE
  To describe the United States Army Ocular Teleconsultation program and all consultations received from its inception in July 2004 through December 2009.
  
  
  METHODS
  Retrospective, noncomparative, consecutive case series.
  
  
  METHODS
  All 301 consecutive ocular teleconsultations received were reviewed. The main outcome measures were differential diagnosis, evacuation recommendations, and origination of consultation. Secondary measures included patient demographics, reason for consultation, and inclusion of clinical images.
  
  
  RESULTS
  The average response time was 5 hours and 41 minutes. Most consultations originated from Iraq (58.8%) and Afghanistan (18.6%). Patient care-related requests accounted for 94.7% of consultations; nonphysicians submitted 26.3% of consultations. Most patients (220/285; 77.2%) were United States military personnel; the remainder included local nationals and coalition forces. Children accounted for 23 consultations (8.1%). Anterior segment disease represented the largest grouping of cases (129/285; 45.3%); oculoplastic problems represented nearly one quarter (68/285; 23.9%). Evacuation was recommended in 123 (43.2%) of 285 cases and in 21 (58.3%) of 36 cases associated with trauma. Photographs were included in 38.2%, and use was highest for pediatric and strabismus (83.3%) and oculoplastic (67.6%) consultations. Consultants facilitated evacuation in 87 (70.7%) of 123 consultations where evacuation was recommended and avoided unnecessary evacuations in 28 (17.3%) of 162 consultations.
  
  
  CONCLUSIONS
  This teleconsultation program has brought valuable tertiary level support to deployed providers, thereby helping to facilitate appropriate and timely referrals, and in some cases avoiding unnecessary evacuation. Advances in remote diagnostic and imaging technology could further enhance consultant support to distant providers and their patients.
authors.affiliation: Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. Michael.mines@amedd.army.mil
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mines
authors.forename: Kraig S
authors.initials: KS
authors.lastname: Bower
authors.forename: Charles M
authors.initials: CM
authors.lastname: Lappan
authors.forename: Robert A
authors.initials: RA
authors.lastname: Mazzoli
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Poropatich
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005128:Eye Diseases / Q000175:diagnosis; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000706:statistics & numerical data*; D009885:Ophthalmology / Q000706:statistics & numerical data*; D019114:Remote Consultation / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D014857:Warfare; D055815:Young Adult