donation from the Henry and Corrine Bower Laboratory, Philadelphia, PA. Our ophthalmic photographer supervised the photo acquisition and instructed the local technicians in the use of the camera (Figs. 14.2 and 14.3).

The pictures were uploaded from the camera onto an Internet server and evaluated by ophthalmologists at Tilganga Eye Center as well as by a retina specialist in the USA.

14.3Discussion

The nonmydriatic fundus camera was easy to use, and local technicians acquired proficiency after approximately 15 min training with the device. The transmitted images were of good quality, thus allowing accurate diagnosis and grading of fundus pathology comparable with the examination by the ophthalmologists on site (Figs. 14.4 and 14.5).

However, there were several obstacles encountered during this first test with telemedicine in Nepal. The camera is expensive (approximately $40,000) and not designed for transportation between different locations. Transporting the camera in its original box from the USA by plane resulted in damage to the camera base tracking mechanism. Nidak currently does not have a representative present in Nepal for servicing, training, or repairs.

Once the camera was installed and running, power supply was unreliable given frequent scheduled and unscheduled power outages.

Uploading the pictures to the Internet proved to be a significant problem due to large data size and slow Internet speed (dial-up), software issues, as well as shortage of manpower from Nepalese technicians.

14.4Conclusion

Telemedicine in ophthalmology would seem to be a good fit for rural Nepal with its shortage of subspecialists, rugged terrain, and poor infrastructure.

However, before implementing the use of telemedicine on a routine basis, several issues need to be addressed to guarantee smooth functioning. The impending introduction of high-speed Internet as well as improvement in power supply will allow faster electronic transmission of data and timely analysis of images from a distance and thus hopefully help overcome these issues in the future.

References

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2. Peng JJ, Zou HD, Wang WW et al (2010) The application study of community-based tele-screening system for diabetic retinopathy in Beixinjing Blocks, Shanghai. Zhonghua Yan Ke Za Zhi 46(3):258–262

3. Ulrich JN, Poudyal G, Marks SJ et al (2009) Ocular telemedicine between Nepal and the USA: prevalence of vitreoretinal disease in rural Nepal. Br J Ophthalmol 93(5):698–699