The role of telemedicine in the assessment of strabismus.

Thirty patients with strabismus were seen face to face by an ophthalmologist and an orthoptist. The patients were then presented by the same orthoptist to a second ophthalmologist via a telemedicine link. Twenty-six patients were seen using a bandwidth of 384 kbit/s and four using 128 kbit/s. There was agreement between the two ophthalmologists about diagnosis and management in 24 cases, partial agreement in one and no agreement in five (17%). Manifest strabismus was safely diagnosed and managed using telemedicine at 128 kbit/s, although 384 kbit/s was preferred because it obviated the need for repeated examination. Latent strabismus and micro-movements were difficult to diagnose using telemedicine even at 384 kbit/s. Young patients who are unable to sit still would not be suitable for strabismus assessment via telemedicine.