Improved access to quality eye care

Some eye diseases, such as diabetic retinopathy, are most treatable when they are asymptomatic. The challenge is that appointments with ophthalmologists can be months away and involve significant travel and related expenses. OTN’s Teleophthalmology store forward service enables timely, accessible eye care, so eye disease is more likely to be discovered, and treated, before irreversible vision loss.


  • A patient history, accompanied by special images of the eye, are uploaded to the OTN secure store forward network.
  • The consulting ophthalmologist reviews the file and completes a clinical report, including a diagnosis and appropriate treatment recommendations.
  • Patients are then either referred for ongoing care from a local optometrist, or specialty care from an ophthalmologist.
flow chart of 4 steps to use Teleopthalmology


For providers

  • easier access to retinopathy screening for diabetic patients experiencing barriers to routine eye care
  • more effective triage of patients needing specialized eye care
  • improved clinical support for local eye care providers, so fewer patients have to travel

For patients

  • Diabetic patients who live a prohibitive distance from the nearest optometrist can be screened for retinopathy, close to home, by their community health nurse.
  • Rather than referring their patient for an in-person visit to the ophthalmologist, involving a five-month wait and a day off of work, an optometrist can receive a virtual consultation from an ophthalmologist within 5 days. Patients are then either triaged to in-person care from the ophthalmologist, or on-going care from the optometrist with helpful guidance from the ophthalmologist.
  • Patients under the specialty care of an ophthalmologist can avoid unnecessary travel for follow-up care, by having images of their eyes uploaded to the secure OTN network.

“People can have serious retinal disease but still see perfectly well, so they have no idea the danger they are in. Because I am able to screen them, even over great distances, I am sometimes able to avert serious problems, and in some cases even blindness.”

 – Dr. Stephen Kosar, Ophthalmologist


Considering adding Teleophthalmology to your organization’s service offering? Teleophthalmology may be a valuable addition if:

  • Your community has a large number of patients with diabetes who have not been seen by an eye care professional in the last two years, as per Canadian Diabetes Association guidelines.
  • You have a system that allows you to easily identify these unscreened patients.
  • You have a good working relationship with your local optometrists.

Site Readiness
Those interested in hosting Teleophthalmology services will want to consider:

  • How many patients would benefit from teleophthalmology services in your area? What are their barriers to accessing eye care, and can store-forward teleophthalmology address these barriers?
  • Are there two health care providers who can complete the half-day training and maintain their skills to provide consistent coverage?
  • Is there an existing referral network of health care providers, organizations, optometrists, etc. that can be leveraged for referrals and follow-up care?
  • Are senior leadership teams and the LHIN supportive of a teleophthalmology service at this site?

Required Resources
OTN will provide these services at no charge to new Teleophthalmology sites:

  • Site start-up coaching and consultation
  • Centralized Teleophthalmology store-forward software and data storage
  • Software training and 7:00 am-7:00 pm weekday service support
  • Change management support to achieve optimal screening volumes.

Sites interested in hosting Teleophthalmology services would be responsible for the following costs, depending on their business model and available resources:

Equipment and Software Costs
Fundus camera and/or OCT scanner equipment and installation $27,000+
Tonopen (for testing eye pressures) $4,000
Total One-Time Costs: $35,000+
Support Resources
Imaging Technician (RN, RPN, NP, etc.),- 0.1-0.8 FTE $7,000 – $56,000/year
Administrative Support,- 0.1-0.2 FTE $6,000 – $12,000/year
Service warranty for fundus camera/OCT scanner $3,000 – $7,500/year
Travel (if providing mobile services) variable
Total Annual Costs: $16,000 – $75,500+/year

Insured Services
The OHIP fee codes for e-assessments allow ophthalmologists to bill for remote consultation, including interpretation of images of the eye. They also allow primary care physicians to bill for making the referral, if the physician is being compensated using a fee-for-service model. Our Teleophthalmology team can provide you with more details.

Image Capture Equipment
The Teleophthalmology service currently supports several different types of fundus cameras and OCT scanners. If you have an imaging device, it is very likely that it will work on our store forward system. If you do not yet have an imaging device, our Teleophthalmology team can help you select one appropriate to your program needs.


Cost-Utility Analysis of Telemedicine and Ophthalmoscopy for Retinopathy of Prematurity Management

This article concludes that telemedicine is more cost-effective than standard ophthalmoscopy for ROP management, and that both strategies are highly cost-effective compared with other health care interventions.

Fundus Photography in the 21st Century—A Review of Recent Technological Advances and Their Implications for Worldwide Healthcare

This is a description of the fundus camera throughout its development, including current and anticipated advances.

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

This is a summary of the UK diabetic retinal screening program, which uses teleophthalmology technology.