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Telemedicine uses the internet to allow remote diagnosis and treatment of patients who cannot travel to a hospital, due to distance or cost. Teleophthalmology is a specialized type of telemedicine customized for eye care that can deliver quality eye care to remote and rural locations. With growing internet access in rural India [1], teleophthalmology has become a practical alternative to in-person consultations with an ophthalmologist. But in addition to improved eye care access, teleophthalmology may have environmental and economic advantages.
A new study, published in the journal Eye [2], shows that teleophthalmology can lower carbon emissions and increase cost savings. The research was carried out at the L. V. Prasad Eye Institute (LVPEI) by Dr. Padmaja Kumari Rani and her team.
In India, where 70% of the population lives in villages [3], going for an eye checkup often involves a costly long-distance commute to an urban hospital. The CO2 emissions from such travel, involving two-wheelers, auto-rickshaws, trains, or airplanes, add to India’s carbon footprint. Teleophthalmology can reduce the CO2 emissions and costs associated with such long-distance travel.
Studies in high-income nations have shown that telemedicine is a patient- [4] and environment-friendly [5] means of providing healthcare. India has a dearth of good eye hospitals. This puts LVPEI, one of the few Indian hospitals with an extensive network, in a unique position to evaluate the impact of telemedicine in eye care.
In a teleophthalmology session, a patient remotely consults an ophthalmologist using internet-based video chat and image sharing. At LVPEI, this is done in two ways. The patient can either visit a primary eye care center, where a technician performs an eye examination and uploads the report to a cloud-based server. Many kilometers away, an ophthalmologist will examine the report and either prescribe treatment or refer the patient to a hospital if their condition cannot be managed remotely. Alternatively, the patient can use a smartphone app to book an appointment with a doctor, have an online consultation, and download an e-prescription, all through the app itself.
The study included 324 patients—173 from rural primary eye centers and 151 from urban tertiary hospitals—who received teleconsultations from LVPEI within a three-month period. Environmental impact was evaluated by calculating the decrease in CO2 emission, based on the transport used by patients to travel to LVPEI. Economic impact was assessed using estimated cost savings from food, travel, and lost wages.
Patients at primary centers were sorted into ‘green,’ ‘yellow,’ and ‘red’ tags based on medical urgency. Almost 70% of rural patients were tagged ‘green’, i.e., they can be treated via teleconsultation alone. The remaining 30% were referred to a hospital. Their expenses and CO2 emissions were used to calculate the emissions/expense avoided by the ‘green’ patients. Urban patients were classified as ‘new’ or ‘follow-up.’ Their mode of travel and costs were recorded.
Half of the rural patients (49.5%) were estimated to travel by bus, while 38.7% would have used a two-wheeler to access a primary eye center. On average, teleophthalmology saved 80 km of travel and reduced 2.89 kg of CO2 emission, per rural patient. That means around 1.26 liters of petrol was saved by each such patient over the study period.
LVPEI’s tertiary hospitals, located in four southern Indian cities, receive patients from across the country. The study revealed that trains were the primary mode of transport (41%), followed by airplanes (19%), and buses (11%). Each patient who chose teleconsultation saved, on average, 1,666 km of travel and reduced 176.6 kg of CO2 emission. That amounts to 75.9 liters of petrol saved, per patient, over three months.
Less travel also meant more savings. On average, each rural patient saved INR 370, while each urban patient saved INR 8,339 on travel expenses alone. When indirect costs like food and lost wages were factored in, rural patients saved INR 29,100, while urban patients saved over INR 3,45,000, in total.
The study shows that teleophthalmology can be a cost- and carbon-efficient service option for most people and helps tackle the hurdles of cost, distance, and time.
