Original article
The United States Army Ocular Teleconsultation program 2004 through 2009

https://doi.org/10.1016/j.ajo.2011.01.028Get rights and content

Purpose

To describe the United States Army Ocular Teleconsultation program and all consultations received from its inception in July 2004 through December 2009.

Design

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.

Section snippets

Methods

The ocular teleconsultation program is a component of a larger e-mail consultation system described elsewhere (see Supplemental Figure 1, available at AJO.com).6, 7 The program utilizes a pre-existing e-mail communication system known as Army Knowledge Online. Incoming messages are routed automatically from Army Knowledge Online to a global e-mail system (Microsoft Outlook; Microsoft Corporation, Redmond, Washington, USA) used by all United States-based specialty providers. Because of the

Results

From July 2004 through December 2009, a total of 301 ocular consultation requests were received. All consultation requests were answered with an average response time of 5 hours and 41 minutes (range, 5 minutes to 80 hours). The number of different volunteer consultants answering requests gradually increased from 5 in 2004 to 28 in 2009. In 2009, the average number of consultants responding to each request was 1.5, up from 1.0 per consultation in the initial year of the program (see

Discussion

Both the geographic isolation and austere environment of military deployment can dramatically limit communication between far forward providers and rear echelon medical specialists. Unlike community- or hospital-based care, traditional consultative services can be strained or nonexistent. Likewise, evacuation of a military patient not only entails the risks commonly associated with stateside emergency transportation, but also often includes greater logistical coordination while under the threat

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    Supplemental Material available at AJO.com

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    Published by Elsevier Inc.