Table 2 Benefits and disadvantages/barriers of teleophthalmology for patients

Large outreach

Overcomes geographical barriers to healthcare access [116, 117]

Timely evaluation and access to emergency intervention

Addresses coverage gap for emergency eye care and prevent delay in initiation of treatment [118]

Avoiding unnecessary referrals

Proper triaging to select patients who require intervention [e.g. most patients referred for fundal examination by primary care did not require treatment [119]]

Saves cost, time and effort

Teleophthalmology for screening of retinal diseases such as diabetic retinopathy has been shown to be cost-effective [120]

Infection control and protection

Minimises avoidable patient contact, especially for those at a high risk of communicable disease [121]

Comparable diagnostic accuracy

Teleophthalmology consultations have high agreement with face-to-face consultations in the diagnosis of retinal conditions such as AMD [122]

Unfamiliarity

Patients may struggle to access telemedicine due to low digital literacy [123]

Poor image quality

Media opacities (e.g. cataract or vitreous haemorrhage) or poor compliance can lead to inadequate and ungradable fundal images [124]

Privacy and security concerns

Inadvertent transmission of non-clinical information or sharing of data with third-party advertisers may cause patients to lose trust [125]

Patient-doctor relationship

Concerns exist about depersonalisation of the patient-doctor relationship due to a lack of physical interaction which might affect trust and communication [126]