The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 1, January/February 2017 Perspectives

Electronic Referrals and Digital Imaging Systems in Ophthalmology: A Global Perspective

Jeganathan, V. Swetha E.; Hall, H. Nikki; Sander, Roshini

Author Information

From the *Kellogg Eye Center, University of Michigan, Ann Arbor, USA; and †Queen Margaret Hospital, NHS Fife; ‡University of Edinburgh, Edinburgh; and §Princess Alexander Eye Pavillion, Edinburgh, Scotland, UK.


Reprints: V. Swetha E. Jeganathan, MBBS, MPhil (Ophth), MAppMgt (Health), Kellogg Eye  Center, University of Michigan, Ann Arbor, MI 48105 USA. Email:



Ophthalmology Departments face intensifying pressure to expedite sight-saving treatments and reduce the global burden of disease. The use of electronic communication systems, digital imaging, and redesigned service care models is imperative for addressing such demands. The recently developed Scottish Eyecare Integration Project involves an electronic referral system from community optometry to the hospital ophthalmology department using National Health Service (NHS) email with digital ophthalmic images attached, via a virtual private network connection. The benefits over the previous system include reduced waiting times, improved triage, e-diagnosis in 20% without the need for hospital attendance, and rapid electronic feedback to referrers. We draw on the experience of the Scottish Eyecare Integration Project and discuss the global applications of this and other advances in teleophthalmology. We focus particularly on the implications for management and screening of chronic disease, such as glaucoma and diabetic eye disease, and ophthalmic disease, such as retinopathy of prematurity where diagnosis is almost entirely and critically dependent on fundus appearance. Currently in Scotland, approximately 75% of all referrals are electronic from com-munity to hospital. The Scottish Eyecare Integration Project is globally the first of its kind and unique in a national health service. Such speedy, safe, and efficient models of communication are geographically sensitive to service provision, especially in remote and rural regions. Along with advances in teleophthalmology, such systems promote the earlier detection of sight-threatening disease and safe follow-up of non‒sight-threatening disease in the community.

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