title: Telemedicine model to prevent blindness from familial glaucoma.
abstract: BACKGROUND
  To develop, implement and evaluate a telemedicine model to reduce glaucoma blindness through the early detection of undiagnosed glaucoma in high-risk individuals.
  
  
  METHODS
  Prospective study, private ophthalmology practice and public outpatient clinics in Tasmania.
  
  
  METHODS
  One hundred and thirty-three individuals with primary open-angle glaucoma were invited to enrol their first-degree relatives (FDRs) to undergo an eye examination. Within the study period, 211 FDRs were available for examination.
  
  
  METHODS
  A registered nurse was trained to perform the required assessments. Clinical data were entered into a purpose-built database, converted to a portable document format and graded offsite by an ophthalmologist to determine the presence, absence or risk of developing glaucoma. Participants were notified of the grading result and recommendations for review.
  
  
  METHODS
  Incidence of undiagnosed glaucoma in a high-risk population.
  
  
  RESULTS
  Previously undiagnosed glaucoma was identified in 5% of those examined. For every 19 participants screened, one new case of previously undiagnosed case of glaucoma was identified. Additionally 15% of participants showed suspicious signs of glaucoma, and 6% had ocular hypertension.
  
  
  CONCLUSIONS
  A telemedicine model is an efficient method for screening, grading and notifying participants of examination results. Nurses can be adequately trained to undertake the initial screening examinations, with grading of the results performed offsite by a suitably qualified ophthalmologist. Targeted screening for glaucoma increases the yield of identifying individuals with undiagnosed glaucoma or those at greatest risk. Cost efficiencies for this model of glaucoma screening should be further explored and implemented to prevent blindness from familial glaucoma.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Staffieri
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Ruddle
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Kearns
authors.forename: Julie M
authors.initials: JM
authors.lastname: Barbour
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Edwards
authors.forename: Padma
authors.initials: P
authors.lastname: Paul
authors.forename: David A
authors.initials: DA
authors.lastname: Mackey
mesh_terms: D000368:Aged; D001766:Blindness / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological; D020022:Genetic Predisposition to Disease; D005901:Glaucoma; D005902:Glaucoma, Open-Angle / Q000150:complications* / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D007429:Intraocular Pressure; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D013648:Tasmania / Q000453:epidemiology; D017216:Telemedicine / Q000379:methods*