Pathways to Prevention (P2P) Program

Ana Bastos de Carvalho, M.D.

Ana Bastos de Carvalho

University of Kentucky College of Medicine
Assistant Professor, Ophthalmology & Visual Sciences

Presentation Abstract

Methodological Weaknesses of Studies of Provider-to-Provider Telehealth in Rural Patients: The Example of Studies Screening for Eye Diseases 

Background: Teleophthalmology can be used to screen and manage some of the most common causes of blindness, including diabetic retinopathy, glaucoma, age-related macular degeneration, cataract, and retinopathy of prematurity. Teleophthalmology is particularly valuable in underserved areas and rural populations, where access to eye care specialists may be limited. Most teleophthalmology services rely on provider-to-provider interactions, and use digital images captured at the point-of-care, such as in primary care clinics, that are assessed by remote ophthalmologists.

Methods: We reviewed existing rural teleophthalmology programs and their benefits and limitations, as well as studies of effectiveness of provider-to-provider rural teleophthalmology screening. Further, we analyzed methodological gaps in these studies.

Results: We provide a summary of existing rural teleophthalmology programs and propose future research directions to address gaps in studies of effectiveness of provider-to-provider rural teleophthalmology, such as studies of program sustainability, adherence to follow-up and treatment after positive screenings, functional (visual) and quality-of-life patient outcomes, and introduction of innovations that facilitate and lower costs for teleophthalmology screening, such as artificial intelligence (AI).

Conclusion: Teleophthalmology can provide invaluable access to eye care in rural populations but to realize its full potential, future research must address existing gaps in effectiveness studies, as well as ongoing advances such as the utilization of AI.

About Dr. Bastos de Carvalho

Dr. Ana Bastos de Carvalho is a tenure-track Assistant Professor and Medical Retina Specialist in the Department of Ophthalmology & Visual Sciences at the University of Kentucky (UK) College of Medicine. Her research focuses on early detection and treatment of retinal diseases such as diabetic retinopathy (DR), with the overall goal of disseminating best practices for effective implementation of evidence-based blindness prevention interventions.

With the backbone of a state-wide Telemedicine DR Screening (TDRS) hosted by UK, and expanded by Dr. Bastos de Carvalho and her coworkers, her lab investigates barriers and facilitators for TDRS in the primary care setting. They use implementation research to then develop, implement, and sustain strategies for uptake of TDRS in underserved populations, including rural and urban poor in Kentucky.

Dr. Bastos de Carvalho did not disclose any conflicts of interest for this workshop.

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