[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.234.223.162. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 742
Citations 0
Original Investigation
August 27, 2020

Military Teleophthalmology in Afghanistan Using Mobile Phone Application

Author Affiliations
  • 1Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, Maryland
  • 2Department of Surgery, Division of Ophthalmology, Uniformed Services University, Bethesda, Maryland
  • 3Department of Ophthalmology, Navy Medical Center Portsmouth, Portsmouth, Virginia
  • 4US Army Aeromedical Research Laboratory, United States Army Medical Research and Development Command, Fort Rucker, Alabama
  • 5Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland
  • 6Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas
JAMA Ophthalmol. Published online August 27, 2020. doi:10.1001/jamaophthalmol.2020.3090
Key Points

Question  Can a mobile phone application be used for teleophthalmology in a combat zone?

Findings  In this case series of 28 consults, military medics and clinicians at forward operating bases in Afghanistan placed teleophthalmology consults on their mobile phone devices and an expeditionary ophthalmologist deployed to a military hospital in Afghanistan responded. Teleophthalmology consultation prevented the need for some aeromedical evacuations and allowed patients to return to duty in 54% of consults.

Meaning  Teleophthalmology mobile phone apps in this environment may improve and extend ophthalmic care.

Abstract

Importance  The coronavirus disease 2019 pandemic has highlighted the need to expand telemedicine solutions.

Objective  To beta test a secure teleophthalmology mobile app at military treatment facilities in Afghanistan.

Design, Setting, and Participants  This prospective case series included 16 military treatment facilities at diverse roles of care including forward operating bases in Afghanistan and 1 location outside of Afghanistan. Thirty point-of-care medics and medical professionals were included from September to November 2019.

Interventions  Users placed teleophthalmology consults on their mobile phone using the mobile eye care app, and an expeditionary ophthalmologist stationed at a military hospital in Afghanistan responded. Users graded the mobile app using a rating scale from 1 to 5, with 1 being very dissatisfied and 5 being very satisfied.

Main Outcomes and Measures  Mean initial response time, agreement between the teleophthalmology diagnosis and final diagnosis, treatment and management following recommendations outlined in the Joint Trauma System clinical practice guidelines, prevention of the need for aeromedical evacuation, user satisfaction, and security and the Health Insurance Portability and Accountability Act compliance of consult.

Results  There were 28 consults placed over 6 weeks by 18 different users that were received by the expeditionary ophthalmologist. The mean (SD) patient age was 30.3 (9.8) years. Most patients were male (26 [93%]) and active duty US military (22 [78%]). The mean initial response time was 3 minutes 58 seconds (95% CI, 2 minutes 30 seconds to 5 minutes 26 seconds). There was agreement between the teleophthalmology diagnosis and final diagnosis in 24 consults (86%; 95% CI, 72%-100%). The treatment and management followed recommendations outlined in the Joint Trauma System Clinical Practice Guidelines for Eye Trauma: Initial Care in 28 consults (100%). Teleophthalmology consultation prevented the need for aeromedical evacuation in 4 consults (14%; 95% CI, 0.7%-28%). The patient returned to duty in 15 consults (54%; 95% CI, 34%-73%). Median overall satisfaction was 5 (minimum, 3; maximum, 5). All 28 consults (100%) were secure and compliant with the Health Insurance Portability and Accountability Act.

Conclusions and Relevance  While only a limited number of consults were evaluated, this study suggests that teleophthalmology mobile phone apps may improve and extend ophthalmic care in combat zones.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×