A prospective evaluation of the clinical safety and effectiveness of a COVID‐19 Urgent Eyecare Service across five areas in England

Abstract

Purpose Although urgent primary eye care schemes exist in some areas of England, their current safety is unknown. Accordingly, the aim of the present study was to quantify the clinical safety and effectiveness of a COVID‐19 Urgent Eyecare Service (CUES) across Luton, Bedford, Hull, East Riding of Yorkshire and Harrogate. Methods Consenting patients with acute onset eye problems who had accessed the service were contacted to ascertain what the optometrist's recommendation was, whether this worked, if they had to present elsewhere and how satisfied they were with the CUES. Results A total of 27% (170/629) and 6.3% (28/445) of patients managed virtually and in person, respectively, did not have their acute eye problem resolved. Regression analysis revealed that patients who attended a face‐to‐face consultation were 4.66 times more likely to be correctly managed [Exp (β) = 5.66], relative to those solely managed virtually. Optometrists' phone consultations failed to detect conditions such as stroke, intracranial hypertension, suspected space occupying lesions, orbital cellulitis, scleritis, corneal ulcer, wet macular degeneration, uveitis with macular oedema and retinal detachment. Of referrals to hospital ophthalmology departments, in total, 19% were false‐positives. Patients, however, were typically very satisfied with the service. Uptake was associated with socioeconomic status. Conclusion The present study found that a virtual assessment service providing optometrist tele‐consultations was not effective at resolving patients' acute‐onset eye problems. The range and number of pathologies missed by tele‐consultations suggests that the service model in the present study was detrimental to patient safety. To improve this, optometrists should follow evidence based guidance when attempting to manage patients virtually, or in person. For example, patients presenting with acute‐onset symptoms of flashing lights and/or floaters require an urgent dilated fundus examination. Robust data collection on service safety is required on an ongoing basis.

Author’s Reply

“…Specifically, 19.8% fewer patients re-presented after a face-to-face ophthalmology appointment (15.7% re-present rate) and 26% fewer patients represented after a face-to-face optometry appointment (0.7% re-present rate). Whilst the tele-ophthalmology service 7 differed markedly from that of the service in our study, 2 one distinction is that in the service examined by Li et al, patients were able to choose whether they were seen in person, or virtually. Accordingly, it may be that patients who chose teleconsultation thought their condition was less serious, relative to those who opted to attend in person which reduced instances of actual harm.…”

“…For patients in our study, 26.8% re‐attended (11.1% to the phone line and 15.7% elsewhere) after tele‐consultation. In both studies, 2,7 rates of re‐presentation were lower after a face‐to‐face appointment. Specifically, 19.8% fewer patients re‐presented after a face‐to‐face ophthalmology appointment (15.7% re‐present rate) and 26% fewer patients represented after a face‐to‐face optometry appointment (0.7% re‐present rate).…”

“…We thank Harper et al 1 for their interest in our paper. 2 We agree the safety of commissioned services is of importance, and we believe that novel services should be commissioned with inbuilt service evaluation, but we acknowledge the inherent barriers to doing this. We were grateful that the companies involved in our study were keen to have independent evaluation that enabled system learning and improvement of services.…”

“…This is also in concordance with patient centred care. In the optometry teleconsultations examined by both Williams et al 6 and ourselves, 2 all patients had a telephone consultation before the clinician determined whether a face‐to‐face appointment was necessary.…”

“…An important aspect of recent studies through the COVID-19 pandemic 2,6,9 is that the data suggests that face-to-face emergency eye care delivered by optometrists is safe with low rates of adverse events. Ansari et al 9 reported low rates of referral to hospital ophthalmology departments (5%), with all patients retained in primary care managed to the resolution of their condition by independent prescribing optometrists.…”