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Tele-Education in Ophthalmology: Live Vitreoretinal Surgery Ingrid E. Zimmer-Galler, M.D. Susan Vitale, Ph.D., M.H.S. Wilmer Eye Institute Johns Hopkins Medical Institutions: 

Tele-Education in Ophthalmology: Live Vitreoretinal Surgery Ingrid E. Zimmer-Galler, M.D. Susan Vitale, Ph.D., M.H.S. Wilmer Eye Institute Johns Hopkins Medical Institutions

Tele-Education: 

Tele-Education Interactive Distance Education Two way video Desktop conferencing Multi-media technology Internet Global satellite links

Tele-Education: 

Tele-Education Distance Learning Distance may mean across the room or across the world With telecommunications technology distance is removed or redefined Time, distance, and location are irrelevant

Tele-Education: 

Tele-Education Provides timely instruction to a greater number of individuals Can greatly reduce training expenses Increases productivity Provides greater training flexibility

Tele-Education: 

Tele-Education Interactive, multimedia technologies Video-conferencing CD-ROM/Computer based instruction Internet World Wide Web MEDLINE and other medical databases Computer mediated communications

Tele-Education: 

Tele-Education USUHS Communicate and collaborate with 8 clerkship sites across the US Cleveland Clinic Cole Eye Institute Grand rounds with live audio/video from OR U of Iowa and West Virginia U Ophthalmic pathology virtual classroom

Barriers to Tele-Education: 

Barriers to Tele-Education Insufficient infrastructure and resources to sustain programs Lack of funding Need for cultural change Need for standardization

Live Surgical Procedures: 

Live Surgical Procedures Virtual OR Many observers participate at same time Unique educational experience Gaining popularity

Live Macular Translocation Surgery: 

Live Macular Translocation Surgery Wilmer Eye Institute live broadcast of Limited Macular Translocation Surgery from Baltimore, MD to the 17th Annual Vitreous Society Meeting in Rome, Italy with a simultaneous worldwide live Internet webcast.

Macular Translocation Surgery: 

Macular Translocation Surgery Innovative surgical technique for the treatment of select cases of subfoveal choroidal neovascularization. Pioneered by Eugene DeJuan, MD

Webcast Components: 

Webcast Components Production Signal acquisition Local signal distribution Internet signal distribution

Project Overview: 

Project Overview Source Production Surgery in Wilmer OR and conference room Signal Acquisition Video signal transmitted from source to distribution network via satellite (ISDN backup) Signal Distribution to Rome Meeting Signal Distribution to Internet High capacity video servers High bandwidth distribution network

Satellite Transmission: 

Satellite Transmission

Production: 

Production Audio/Video Source: Microscope Camera Operating Room Camera Interview Room Camera Speaker Phone Connection with Rome Audience

Video Production: 

Video Production

Signal Acquisition: 

Signal Acquisition Source video and audio were fed to an audio/video switch Switch output encoded into IP packets by CODEC (compression/decompression) boards IP packets sent to video server

Videoserver: 

Videoserver Separate server specialized to video streaming task Makes efficient use of bandwidth Offers good video quality Scales to support large number of end users

Network Configuration: 

Network Configuration

Video Source Site Setup: 

Video Source Site Setup

Video Production: 

Video Production

Video Streaming Technology: 

Video Streaming Technology Delivers video directly over Internet without downloading file Requires digital encoding/decoding Necessary buffering results in slight time lag Requires high bandwidth With clustered video servers, thousands of concurrent sessions can be supported

Time Delay: 

Time Delay Compression/decompression of video data imposes a time delay 300 ms Transit time depends on medium and traffic over medium Round trip delay 600 ms Problem for telesurgical procedures

Discussion of Case: 

Discussion of Case

Approximate Costs: 

Approximate Costs Video/Audio Production Satellite Distribution ISDN Links Web Distribution Website Setup Hardware/Software TOTAL (Does not include labor) $12,000 $14,000 $10,000 $9,000 $2,500 $112,000 $159,500

Acknowledgments: 

Acknowledgments Special thanks to Bausch & Lomb Surgical, FastTide, Lucent Technologies, and The Wilmer Eye Institute for their support of the live surgery broadcast with generous educational grants.

Tele-Education: 

Tele-Education

Tele-Education: 

Tele-Education Current technologies designed to work with and make more effective use of information have educational potential that cannot be ignored. Improved and increased provider education translates to higher quality patient care.

Tele-Education: 

Tele-Education An opportunity to bring specialty education to areas of the world not previously reached. Increased provider (and patient) access to education may be an effective way to address the disparity of ophthalmology care in different parts of the world.