We have included example videos if you wish to get a sense of what some of your examinations may be like:
 

The Stanford Automated Teleophthalmology and Universal Screening (STATUS) Program was established in 2020 to increase access to eye exams for patients with diabetes. The Byers Eye Institute at Stanford serves as the center of a Bay Area-wide network of fundus cameras stationed at affiliated primary care clinics where patients can have their eyes tested for diabetic eye disease using state of the art technology.

The STATUS program implements an FDA-approved artificial intelligence algorithm for the detection of referral-warranted diabetic eye disease (retinopathy), as well as other digital health innovations to further enhance access to and the efficiency of eye care through telemedicine. The program partners with the Stanford Ophthalmic Reading Center (STARC) to ensure that all images are interpreted, for instance, if retinal image quality is affected by small pupil size or cataracts. Through this AI-human hybrid workflow, patients with referrable diabetic eye disease are identified remotely and efficiently.

Diabetic eye disease is the leading cause of blindness inworking age adults, and early detection of disease is critical for timely treatment to prevent loss of vision and blindness. Through partnerships with primary care clinics in Santa Clara, Los Gatos, Hayward, Emeryville, Castro Valley, and Pleasanton, and Hoover Pavilion at Stanford, patients with diabetes can have photos of their retinas taken, with their images interpreted by FDA-cleared Artificial Intelligence (AI) technology and, if needed, by the Stanford Ophthalmic Reading Center (STARC). Patients are notified if they need to be seen in-person by an eye doctor, or can photographed again in a year.

If no damage or progression is seen, then patients can continue follow up remotely through this program, typically on an annual basis. For more information about the STATUS program, please contact the clinic closest to you here.

There are fewer than 500 neuro-ophthalmologists in the US and less than half as many clinical full-time equivalents, concentrated in major academic or urban centers. Routine outpatient evaluations often schedule 3-4 months ahead, which can result in poor access to care for many. 

Many of the limitations of the current practice of consultative neuro-ophthalmology stem from a traditional model of medical care where patient and provider are in the same physical space at the same time.

Being in the same place at the same time requires:
· extensive travel for the patient
· allocation of space for the visit
· schedule coordination

Telemedicine approaches can eliminate the need for the patient and provider to be spatially coincident.  In asynchronous approaches the requirement for being temporally coincident is also relaxed. 

At Stanford, we have implemented three telemedicine strategies to improve access to care and improve convenience while continuing to deliver high quality expert neuro-ophthalmic care.
 

All neuro-ophthalmology providers at Byers Eye Institute at Stanford are providing neuro-ophthalmic care via video visits.  During a video visit we can:
· Discuss how you are feeling
· Review outside information sent to us by you or your other health care providers
· Check your vision and eye movements
· Show you your testing results such as MRIs and past ophthalmic imaging
· Decide if you need to come for an in person visit or testing
· Recommend next steps for diagnosis and treatment

Don’t have access to video?  For established patients we can offer phone or electronic messaging visits too, though these are more limited in the types of evaluations we can perform.

Schedule a video visit

The neuro-ophthalmology division at Byers Eye Institute at Stanford cares for many people who also see neurologists and neurosurgeons at the Stanford Neuroscience Clinic.  By bringing the eye testing to these clinics, we reduce the need for patients to have a second appointment at the Byers Eye Institute, which is 3 miles away.  This remote testing is similar to our diabetes and neonatal screening programs.

If you are a patient who gets care in the neuroscience clinic and Byers Eye Institute at Stanford, ask your providers if you can take advantage of remote eye testing.

If you have already seen a doctor close to home and have questions about your condition or how to treat it, you may consider an electronic second opinion.  In this process a neuro-ophthalmologist at Stanford will review your medical records and questions and submit written answers for you to review.
 

Dr. Darius Moshfeghi founded the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) program in 2005, and today it remains the oldest and largest telemedicine screening program for in-hospital screening of high-risk infants for treatment-warranted ROP (TW-ROP) in the United States. It is located at satellite neonatal intensive care units (NICUs) situated throughout Northern California and two other states. The goal of the SUNDROP initiative is to reduce blindness and poor visual outcomes from ROP by providing infants in rural and county hospitals with quaternary care.  At  each  site,  all infants  meeting established criteria are screened using RetCam II images, which are subsequently sent to the Stanford University Byers Eye Institute reading centre for remote interpretation by an ROP specialist.

The advantage of this system is that they provide high level care without the travel time, which saves time for the hospital, physicians, and the patient’s family. Moshfeghi has worked with industry both in a consultative and creative-founder role to develop wide-angle imaging camera technology as well as deep learning classifier platforms for the identification of disease in healthy term newborn infants.

Below are Dr. Moshfeghi and Dr. Theodore Leng's report on the 6-year results of the SUNDROP initiative.