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The challenge

Access to eye screening is needed in remote communities

Left undiagnosed and untreated, eye conditions such as diabetic retinopathy can lead to vision loss or total blindness, which can affect a person’s mobility, overall health and quality of life.

Eye screening can help detect eye problems early and enable timely treatment. But in regional and remote areas of Australia, access to regular eye screening can be limited.

Those most at risk in rural and remote areas, such as Indigenous and older Australians, can often succumb to otherwise treatable eye conditions, eliciting a critical need for remote screening technology.

Our response

We've developed new low-cost screening technology

Our researchers at the Australian eHealth Research Centre have developed a low-cost remote telehealth system, called Remote-I, to screen people at risk of eye disease.

We trialled Remote-I in rural areas in Western Australia and Torres Strait.

Remote-I can capture full high-resolution images of a patient’s retina with a special low-cost camera.

The encrypted images are then securely forwarded to a city-based ophthalmologist via a broadband connection for examination, overcoming the need for patients to travel for a live consultation.

Remote-I’s built-in comparisons for various eye diseases can also help local care providers identify people in need of urgent treatment, enabling patients with healthy eyes to avoid filling waiting lists.

[Music plays and text appears on screen: Sight Saving Science for Western Australia]

[Image changes to show a picture of an eye]

[Image changes to show Prof Yogesan Kanagasingam, Research Director, Australian e-Health Research Centre]

Prof Yogesan: My focus is to prevent needless blindness in rural communities, especially in the indigenous population living in rural Western Australia and also in Torres Strait Islands.

[Image changes to show A/Prof Mei-Ling Tay-Kearney, Consultant Ophthalmologist, Royal Perth Hospital]

A/Prof Mei Ling: The prevalence of diabetes in these populations are much, much higher than in the non-indigenous Australians.

[Image changes back to Prof Yogesan Kanagasingam]

Prof Yogesan: It’s about 40 per cent of the aboriginal population have diabetes, and one third of them will develop some sort of eye problem and if they don’t manage very well they can become blind.

[Image changes back to A/Prof Mei-Ling Tay-Kearney]

A/Prof Mei Ling: If one can actually pick up early changes and provide the appropriate intervention, one can actually prevent blindness.

[Image changes back to Prof Yogesan Kanagasingam]

Prof Yogesan: So that’s why we managed to develop this technology and business model where you can actually provide the service directly to the doorstep of people living in rural and very remote areas.

[Image changes to show Jenny having her eyes scanned]

Jenny Day: My name is Jenny Day, my mother was born at Wongawol Station and she’d be known as a Yamaji and I’m a Yamaji woman.

I see retinal diabetes as a disease that the community needs to know a lot more about.

[Image changes to show Jenny Day, Founding Director, Community Development Foundation, addressing the camera]

It’s prevalence is increasing rapidly and we need to get more community involved into what it is and how we can prevent it.

[Image changes to show a silver car driving along a road]

A/Prof Mei Ling: The health worker goes out to the community; clients come in to an office.

[Image changes back to show the health worker scanning Jenny’s eyes]

The health worker then tests their vision and takes pictures of the back of the eye.

[Image changes back to A/Prof Mei-Ling Tay-Kearney at her desk working on a computer]

This health worker then uploads the image onto a computer and from there it’s transmitted across to a website and I, myself, can then access this website from anywhere and anytime. It takes me about five minutes to read the images, create the report and then send it back to the health worker.

[Image changes back to Prof Yogesan Kanagasingam]

Prof Yogesan: This entire program can actually save a lot of money for the health system.

[Image changes back to Jenny Day]

Jenny Day: It means that they’re not uprooted, they don’t need to get themselves organise to come to Perth.

[Image changes back to Prof Yogesan Kanagasingam]

Prof Yogesan: It empowers the local health care workers, screeners and nurses, and also doctors who are practicing in rural areas to make decisions, whether the patient has to be referred or not.

[Image changes back to Jenny Day]

Jenny Day: It can be done in Kalgoorlie, can be done in Leonora, it can be done anywhere.

[Image changes back to Prof Yogesan Kanagasingam]

[Image changes back to show Jenny having her eyes scanned]

Prof Yogesan: We have very successfully implemented this system in China, in Guangdong Province, so if we can implement in China, so why can we not implement in Australia? - it’s only 20-million people.

[CSIRO logo appears with text: Big ideas start here]

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The results

Delivering telehealth systems across Australia

With funding from the Australian Government’s Department of Health and Ageing, we trialled Remote-I in three regional and remote locations across Australia. It was one of the first trials to investigate the practical delivery of health services using telecommunications in rural areas in Australia.

Working with partners Western Australian Health, WA Country Health Service and the Australian Society of Ophthalmologists’ IRIS program, the Remote-I trial screened more than 1,000 patients, and accurately identified 82 cases of diabetic retinopathy, along with 60 cases of diabetic macular odema.

The study found patients were highly satisfied with the Remote-I system, and saved them money they would have spent travelling for specialist eye screening. It also demonstrated that routine (rather than opportunistic) eye examinations are feasible for the early detection of some eye diseases for remote and rural patients.

After achieving successful results in Australia, the CSIRO licenced Remote-I, along with our AI-based screening software, to company TeleMedC.

What’s next for Remote-I?

With funding from the Cooperative Research Centre for Developing Northern Australia, and in collaboration with Queensland Health, we will be looking at validating and establishing tele-ophthalmology services and AI-based image reading in locations in rural and remote Northern Australia.

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