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Novel Use of Telemedicine for Corneal Tissue Evaluation in Eye Banking

Establishing a Standardized Approach for the Remote Evaluation of Donor Corneas for Transplantation

Alabi, Rolake O. MD, PhD*; Ansin, Amy BS; Clover, Jameson CEBT; Wilkins, John MD; Rao, Naveen K. MD§; Terry, Mark A. MD†,¶; Tran, Khoa D. PhD; Sales, Christopher S. MD, MPH*,†

doi: 10.1097/ICO.0000000000001848

Purpose: To determine the feasibility of using telemedicine consultations in the evaluation of recovered donor corneas for transplant suitability.

Methods: This study aims to establish and test the minimum imaging requirements for telemedical consultations of corneal tissue by remote eye bank medical directors. Digital images from the slit lamp, optical coherence tomography, and/or specular microscope were assembled into telemedical consults and emailed to 4 eye bank medical directors (M.A.T., J.W., C.S.S., N.K.R.). Feedback on the minimum image requirements for each corneal finding was collected. After establishing a standardized imaging and presentation protocol, test cases were presented to the medical directors to examine the validity of these remote consults. To establish a benchmark for the study's parameters, one medical director (J.W.) examined each case in person after his initial remote review. Examiners were masked to each other's responses.

Results: Minimum image requirements for determination of corneal findings were defined and were specific to each anatomic layer of the cornea (epithelial, stromal, or endothelial). Using a defined set of digital images for a set of common corneal findings, the rate of agreement between remote evaluators, eye bank staff, and the in-person evaluator was 100% (11 of 11 examples). For ambiguous test cases, remote evaluators agreed on 80% of the cases (4 of 5).

Conclusions: Results from this pilot study suggest that telemedical review of corneal tissue using high-quality digital images may be adequate for accurate identification of specific corneal findings commonly encountered by eye banks.

*Department of Ophthalmology, Weill Cornell Medical College, New York, NY;

Vision Research Laboratory, Lions VisionGift, Portland, OR;

The Eye Clinic, P.C., Portland, OR;

§Lahey Medical Center, Peabody, MA; and

Devers Eye Institute, Portland, OR.

Correspondence: Christopher S. Sales, MD, MPH, Weill Cornell Medical College, 1305 York Avenue, New York, NY 10021 (e-mail:

Supported in part by a NIH T32GM007739 to the Tri-Institutional MD-PhD program (ROA).

The authors have no conflicts of interest to disclose.

R.O. Alabi and A. Ansin contributed equally to this work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received August 27, 2018

Accepted November 14, 2018

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