Teleophthalmology for the elderly population: a review of the literature

Authors: Fatehi F, Jahedi F, Tay-Kearney ML, Kanagasingam Y.

Geographical coverage: Europe, North America, Asia, Middle East, Africa and Oceania

Sector: Biomedical

Sub-sector: Screening, diagnosis

Equity focus: Not reported

Study population: Individuals aged 65 years and over

Review type: Effectiveness review

Quantitative synthesis method: Not applicable

Qualitative synthesis method: Qualitative synthesis using a four pillars framework

Background: The prevalence of age-related eye diseases is consistently increasing due to the increase in ageing populations. The delay in diagnosis and treatment results may cause irreversible vision loss. Early screening is therefore recommended and is the most cost-effective option. Teleophthalmology is gaining popularity in this field as it reduces travel and time inconveniences. It is particularly more popular in rural areas and underserved populations. However, the extent of its usability in older adults and the aged population is not well documented.

Objectives: To investigate the characteristics and usability features of teleophthalmology for the elderly population.

Main findings: A total of 514 articles were identified from the searches, of which 45 were included in this review. Twenty-six of the 45 included studies were feasibility trials of a new teleophthalmology intervention, 12 were comparative studies comparing teleophthalmology solutions with the conventional functionalities, and four used teleophthalmology to assess the prevalence of diseases. None of the included studies were conducted specifically on the elderly population. Ten teleophthalmology interventions were conducted in Europe, 14 in North America, three in Asia, two in the Middle East, two in Africa, and two in Oceania. Diabetic retinopathy, glaucoma, age-related macular degeneration and cataract were the most researched eye diseases. Retinal photography had been used the most (72%) among the imaging technologies. The studies showed teleophthalmology can enhance access to speciality care, reduce the number of unnecessary visits, alleviate overloads on treatment centres, and provide more comprehensive exams. Additionally, it proved to be a cost-saving option for stakeholders and economically efficient in rural regions. Nevertheless, it was found to be less cost-effective for individuals aged 80 and above, as well as in areas with low population density.

The review authors noted a lack of evidence for the usability and effectiveness of teleophthalmology for the elderly population. However, the evidence suggests that suitable training for primary care physicians, and collaboration between primary care providers and ophthalmologists could provide more effective eye care to the elderly. In addition, the authors proposed conducting further research to improve diagnostic value and cost-effectiveness of imaging modalities to make teleophthalmology more usable for the elderly population.

Methodology: Searches were conducted in PubMed, EMBASE, Scopus and CINHAL databases to identify studies conducted on teleophthalmology for the elderly population aged 65 years or over. Searches were restricted to peer-reviewed articles published in the English language from 2008 to 2018. For data extraction and synthesis, the authors developed a framework inspired by recent systematic reviews on teleophthalmology conducted in the USA, UK and Europe. The framework was comprised of four pillars: functionality, diseases, technology (telecommunication and medical) and staff. The results were quantitatively described and cross-tabulated in several matrices. Furthermore, the limitations and conclusions of the included studies were analysed and consolidated.

Applicability/external validity: The authors did not discuss the generalisability of findings. However, they do note that most of the benefits of general teleophthalmology are applicable to the elderly population, but there are some limitations that should be addressed.

Geographic focus: Authors reported included studies from across the globe, however, the applicability of findings was not discussed.

Summary of quality assessment:

Several limitations were noted in the methodology of this review. The literature search was confined to peer-reviewed articles written solely in English. The authors did not clearly articulate whether they used specific methods to select studies for inclusion or to extract data from those that were included. Furthermore, there was no indication of any risk-of-bias assessment for the included studies. Due to these factors, the conclusions of this review are regarded with low confidence.