This chapter provides an introduction to general telehealth and a more detailed introduction to ocular telehealth. Factors to consider for implementation of ocular telehealth programs such as patient and provider buy-in, the digital divide, legal, reimbursement, and technology considerations are highlighted. Finally, common telehealth terms that are used throughout the rest of the book are defined for the reader.

Akin to two people not speaking a common language (Fig. 1.1.1), ophthalmologists are unable to unambiguously communicate with each other if the terms they use to describe an eye injury are not standardized. If the terms used do not have straightforward definitions, practitioners cannot understand each other when discussing an ocular trauma case, nor can research be conducted, and its results published, without the risk of the data being misinterpreted. There are very few publications in the literature that provide definitions for the terms used, and those that do may not enforce its own definitions [1]. Consequently, inconsistencies are often found even within the same publication. Common problems include: • Use of different terms to describe the same injury (“double penetrating” [15], “double-perforating” [17] and “perforating” [7]) • Use of the word “blunt” without specifying whether it refers to the agent or to the resulting injury [8] • Alternatively using, even within the same publication, two different terms (penetrating, perforating) to describe the same injury [11] • Use of the term “penetrating” to describe any open globe injury [3] • Use of the term “rupture” to describe any open globe injury [16] • Lack of indicating the tissue of reference when using the term “perforating” [4]

Background Since first being reported in the ophthalmology literature in 2010, three cases (one fatal) of suspected venous air embolism (VAE) during vitrectomy have received little notice, and the vitrectomy/VAE connection has been described as unproven. We investigated the ability of air to exit the eye through vortex veins after accidental suprachoroidal air infusion.Methods Vitrectomy was performed on four donor eyes. Unsutured cannulas were partially withdrawn during air fluid exchange, producing choroidal detachments that emulated accidental suprachoroidal air infusion from a slipping cannula. Eyes with and without clamping of the vortex vein stumps were partially submerged in a water bath.Results Extensive choroidal detachment was created in all eyes during air infusion. All eyes with open vortex veins demonstrated rapid air extravasation/bubbling. An eye with clamped vortex vein stumps showed no air extravasation until the clamps were removed.Conclusions When combined with existing clinical reports of suspected VAE in the eyes of living patients during ocular air fluid exchange, this experiment justifies recognition of presumed air by vitrectomy embolisation (PAVE) as a rare but potentially fatal vitrectomy complication. Simple surgical precautions can change PAVE from a 'rare event' to a 'never event', beginning with acknowledgment of its existence.

OBJECTIVES:To report a patient with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) who developed a thalamic infarction and to discuss this unusual presentation.DESIGN:Interventional case report and literature review.METHODS:A 23-year-old man with APMPPE presented with acute confusion and memory loss. He underwent complete ophthalmologic and neurologic examination, with neuroimaging including magnetic resonance angiography (MRA).MAIN OUTCOME MEASURES:Clinical course and angiographic findings.RESULTS:Magnetic resonance imaging (MRI) showed a left posteromedial thalamic infarction, with a corresponding filling defect of the left posterior communicating artery demonstrated by MRA. The patient underwent further treatment with intravenous corticosteroids followed by continued oral therapy with taper over several weeks.CONCLUSION:Although the association of APMPPE and cerebral vasculitis has been described, this patient is unique due to the subtle clinical presentation and anatomic location. This case emphasizes the importance of appropriate counseling of patients with APMPPE, as well as prompt recognition of clinical symptoms to enable timely intervention and treatment.