Dr. Jorge Camara on the left monitor, chief of ophthalmology at St. Francis Hospital, recently had a telemedicine clinic with North Hawaii Community Hospital in Waimea on the Big Island. The eye of patient Laura Boehm, in Waimea, is seen on the right monitor.

Lights. Camara. Action!

St. Francis' Dr. Jorge Camara
uses camera technology to bring sight
to those suffering on the Big Island

By Helen Altonn

Telemedicine is being used increasingly between St. Francis Medical Center and the North Hawaii Community Hospital in Waimea to save patients with complicated eye problems the time and cost involved in flying to Honolulu to see a specialist.

"We hope it will be ongoing and stimulate further development of telemedicine not just in our state, but the whole world," said Dr. Jorge Camara, reconstructive eye surgeon and chief of ophthalmology at St. Francis.

Dr. Susan Senft, Big Island ophthalmologist, recently presented some of her patients to Camara in a Telemedicine Eye Clinic. Camara was at St. Francis; Senft and the patients were at the Waimea hospital.

Among them was Danelle Rodrigues, who underwent historic eye surgery via telemedicine four years ago on the Big Island at age 16. Senft removed a tumor from her orbital eye socket, guided by Camara in Honolulu.

The first use of telemedicine for eye surgery, it was aired around the world by CNN and "NBC Nightly News."

The two hospitals have continued to hold telemedicine clinics for diagnostic purposes, using high-speed communication lines and sophisticated digital imaging equipment.

The patient's eyes and orbits can be seen clearly, as well as CAT and MRI scans.

"How have you been since I last saw you over telemedicine?" said Camara, chatting with Danelle and asking about her family. "I'm good. I finished school and I'm working," she said.

Zooming in on Danelle's eye with a high-resolution camera, Senft noted just "a little bit of a scar" and no signs of the tumor returning.

Camara said the tumor was very large, and "it was a very difficult procedure done only in few hospitals in the United States. You did beautiful surgery," he told his Kona colleague, closely examining Danelle's eye on the video. "Danelle, you look good and it healed beautifully."

"It's the teacher that makes the difference," Senft said. "It's Danelle who really benefited."

Senft also presented Camara with several patients with bulging eyes due to thyroid disease and others with blocked tear ducts.

Camara developed a laser surgical procedure for blocked tear ducts in 1992 and has conducted hundreds of tear-duct operations, including one in 1998 that was telecast from St. Francis to doctors in the Philippines. He suggested such surgery might relieve eye tearing and infections plaguing Laura Boehm, an intensive-care nurse at the North Hawaii hospital.

Boehm said the ability to consult with the doctors by telemedicine was "absolutely wonderful" because of the difficulty and cost of traveling to Oahu. "I got my questions answered, and the doctors were able to discuss it, too."

George Mueller, who has thyroid eye problems and cataracts, told Camara his vision "is really messed up," with his eyes constantly watering. "It's like my orbs are being squeezed."

Camara suggested a decompression procedure to move the right eye further back in the socket and relieve pressure on the optic nerve. He said this would reduce Mueller's double vision, but it cannot be eliminated.

The ophthalmologists studied sharp details of a CAT scan of Jan Pubanz's eye. "The resolution is incredible," Senft said.

Camara first saw Pubanz in 1983 for thyroid eye disease. Now Senft's patient, the 52-year-old woman said she is experiencing severe fatigue, headaches, bad pains behind the eyes, blurry eyes and low-grade fevers.

Camara recommended that she consult an endocrinologist about possible hypothyroidism, saying he thought she would improve dramatically if her thyroid condition was corrected.

"This conference is very helpful because face-to-face we can address these issues and solve them," Senft said.

The human touch is missing in telemedicine, but it is more personal than relaying information by letters or phone calls because "the patient is right there," Camara said.

"Hopefully, this will be a start of telemedicine used routinely not just in ophthalmology, but in other fields as well," he said, noting it can be used to help people in remote areas who do not have access to care or cannot afford to travel to an expert.

"The implications are tremendous," he said. "We've shown wonderful things can be done with it."

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