Extending the reach and task-shifting ophthalmology diagnostics through remote visualisation

Mario Ettore Giardini, Iain A.T. Livingstone

Research output: Chapter in Book/Report/Conference proceedingChapter


Driven by the global increase in the size and median age of the world population, sight loss is becoming a major public health challenge. Furthermore, the increased survival of premature neonates in low- and middle-income countries is causing an increase in developmental paediatric ophthalmic disease. Finally, there is an ongoing change in health-seeking behaviour worldwide, with consequent demand for increased access to healthcare, including ophthalmology. There is therefore the need to maximise the reach of resource-limited ophthalmology expertise in the context of increasing demand. Yet, ophthalmic diagnostics critically relies on visualisation, through optical imaging, of the front and of the back of the eye, and teleophthalmology, the remote visualisation of diagnostic images, shows promise to offer a viable solution.
In this chapter, we will firstly explore the strategies at the core of teleophthalmology and, in particular, real-time vs store-and-forward remote visualisation techniques, including considerations on suitability for different tasks and environments. We will then introduce the key technologies suitable for teleophthalmology: anterior segment imaging, posterior segment imaging (retinal imaging) and, briefly, radiographic/tomographic techniques. We will highlight enabling factors, such as high-resolution handheld imaging, high data rate mobile transmission, cloud storage and computing, 3D printing and other rapid fabrication technologies, and patient and healthcare system acceptance of remote consultations. We will then briefly discuss four canonical implementation settings, namely national service provision integration, field and community screening, optometric decision support, and virtual clinics, giving representative examples. We will conclude with considerations on the outlook of the field and, in particular, on artificial intelligence, and on robotic actuation of the patient endpoint as a complement to televisualisation.
Original languageEnglish
Title of host publicationBiomedical Visualisation
EditorsPaul M Rea
Place of PublicationSwitzerland
ISBN (Electronic)978-3-030-47483-6
ISBN (Print)978-3-030-47482-9
Publication statusAccepted/In press - 3 Jun 2020

Publication series

NameAdvances in Experimental Medicine and Biology
ISSN (Print)0065-2598


  • telemedicine
  • teleophthalmology

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    Giardini, M. E., & Livingstone, I. A. T. (Accepted/In press). Extending the reach and task-shifting ophthalmology diagnostics through remote visualisation. In P. M. Rea (Ed.), Biomedical Visualisation (Vol. 8). (Advances in Experimental Medicine and Biology; Vol. 1260). Switzerland: Springer.