To the Editor: Telemedicine in eye care (teleophthalmology) is one of the established technologies in medicine, providing the means for undertaking sophisticated eye care and for maintaining contact with patients in rural and remote areas.1

Telemedicine in Australia has been primarily facilitated by government, against a background of complex funding arrangements and interwoven healthcare responsibilities (it is funded mostly by project grants and state government telehealth initiatives).2 This funding mechanism impedes the efficient use and integration of telemedicine services.2

The current healthcare environment demands a detailed economic evaluation to justify continuous funding for teleophthalmology. However, some of the economic benefits of teleophthalmology may not be directly visible in the healthcare system itself. Significant benefit may be obtained by, for example, savings in time and travel expenses, thereby contributing to society indirectly. Furthermore, the cost-effectiveness of a telemedicine service improves considerably when it is integrated with existing routine healthcare services.3 But organisational and attitudinal barriers and lack of funding have delayed such integration.4 These barriers relate to human resource allocation issues in an already overstressed healthcare system and the mindset of some critics who view telemedicine as a peripheral activity and a “novelty” area for technological enthusiasts. The cost-effectiveness of telemedicine will not be improved unless the perception that it is an “add on” is changed.4

The question of whether teleophthalmology should be integrated into routine services, with Medicare reimbursement, can be judged by four criteria:5

• Is the technology sound? (ie, does it fulfil its purpose?)

• Is the program effective compared with existing care?

• Is the program cost-effective?

• Is the program practical? (ie, are there any significant problems associated with it?).

On the basis of our own comprehensive evaluation of teleophthalmology in Western Australia,6 we believe that all four questions can be answered affirmatively, and that teleophthalmology would be most efficiently provided if integrated into existing healthcare services. Its inclusion in the Medicare Benefits Schedule would benefit many patients in remote and rural areas in Australia.