Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults

Noha Sharafeldin, Atsushi Kawaguchi, Aishwarya Sundaram, Sandy Campbell, Chris Rudnisky, Ezekiel Weis, Matthew T.S. Tennant, Karim F. Damji

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


Background/aims Teleophthalmology is well positioned to play a key role in screening of major chronic eye diseases. Economic evaluation of cost-effectiveness of teleophthalmology, however, is lacking. This study provides a systematic review of economic studies of teleophthalmology screening for diabetic retinopathy (DR), glaucoma and macular degeneration. Methods Structured search of electronic databases and full article review yielded 20 cost-related articles. Sixteen articles fulfilled the inclusion criteria and were retained for a narrative review: 12 on DR, 2 on glaucoma and 2 on chronic eye disease. Results Teleophthalmology for DR yielded the most cost savings when compared with traditional clinic examination. The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates. The required patient pool size to be screened varied from 110 to 3500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilisation of the equipment. Teleophthalmology for glaucoma was more cost-effective compared with in-person examination. Similarly, increasing number of glaucoma patients targeted for screening yielded more cost savings. Conclusions This economic review provides supportive evidence of cost-effectiveness of teleophthalmology for DR and glaucoma screening potentially increasing screening accessibility especially for rural and remote populations. Special selection of the targeted screening population will optimise the cost-effectiveness of teleophthalmology.

Original languageEnglish
Pages (from-to)1485-1491
Number of pages7
JournalBritish Journal of Ophthalmology
Issue number11
Publication statusPublished - Nov 2018
Externally publishedYes


  • Teleophthalmology
  • cost-effectivness
  • diabetic retinopathy
  • glaucoma
  • macular degeneration
  • systematic review


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