Expanding the role of medical retina virtual clinics using multimodal ultra-widefield and optical coherence tomography imaging

Abstract

BackgroundAn increasingly elderly population with a corresponding increase in ophthalmic conditions has led to increased pressure on hospital eye services (HES). In this study, we evaluated the use of a medical retina virtual clinic (MRVC), which has expanded into assessing all new medical retina referrals, where the need for urgent treatment was not clear.MethodsRetrospective analysis of all new patients who were seen in the MRVC between April 2016 and May 2018. Pro forma sheets were used in the MRVC to record the patient history, visual acuity, and type of imaging required. Two consultants reviewed the completed pro formas and images and provided a final diagnosis and management plan. These results and reasons for face-to-face (F2F) clinic appointment requests were analyzed.ResultsSix hundred ten new referrals were enrolled in the virtual clinic. The most common diagnosis was diabetic eye disease (59.9%). In the virtual clinic 44.1% were followed up, 28.1% were discharged, and 27.8% were booked an F2F clinic appointment (urgent/routine). The main reason for F2F clinic was to offer treatment. Urgent F2F appointments took place on average 11.9 days after virtual clinic attendance. In only two cases was the image quality felt to be inadequate to assess the retina.ConclusionsMRVC is an effective way of triaging medical retina referrals to allow those patients needing treatment to be seen promptly in the medical retinal service. The use of multimodal ultra-widefield and optical coherence tomography imaging allows assessment of a wide range of retinal pathologies and is a promising solution to alleviate the burden on HES.

The retinal lesions in ultra-wide-field retinal imaging and the consistency of different fundus screening methods in HIV/AIDS patients

“…Non-contact Daytona UWF fundus imaging system in this study provides 200° range of retinal imaging, and brings great convenience for ophthalmic clinic. A large number of studies have been conducted on the observation of peripheral retinal conditions of fundus diseases through UWF laser scanning ophthalmoscopy [8] , aiming to reduce the burden of ophthalmic outpatient service by combining with optical coherence tomography for virtual retinal outpatient service [9] . With UWF fundus imaging, we confirmed that the most common HIV-related fundus changes were HIV-related MVR, followed by CMVR, which met the results of another group's study [3,10] .…”

<p>Providing a Safe and Effective Intravitreal Treatment Service: Strategies for Service Delivery</p>

“…Virtual clinics may be an option when staffing/clinic rooms for disease assessments are limited. In general, the clinician assessing the data virtually, can assess at least double the number of patients who would have been seen in a face-to-face clinic, 30 Furthermore, by acquiring assessment data at a different time to the review, the data acquisition clinics can be planned for a time when the required equipment (eg, optical coherence tomography [OCT] scanners, LogMAR charts) is ordinarily not in use, such as at the weekends or in the evenings.…”

“…Virtual clinics are helpful for chronic diseases when repeat follow-up diagnostic assessments are needed, including nAMD, diabetic retinopathy (DR), glaucoma, choroidal naevi, sickle cell retinopathy and, more recently, hydroxychloroquine retinopathy. 1,[30][31][32][33] Some services use virtual clinics as a rapid means of disease triage for new referrals for intravitreal therapy so that best use can be made of limited baseline specialist clinic slots. 30,34 New patient OCT triage, such as those from fast-track nAMD referrals or M1-graded patients from DR screening exemplify the use of virtual review for VA/OCT data analysis in order to increase throughput.…”

“…1,[30][31][32][33] Some services use virtual clinics as a rapid means of disease triage for new referrals for intravitreal therapy so that best use can be made of limited baseline specialist clinic slots. 30,34 New patient OCT triage, such as those from fast-track nAMD referrals or M1-graded patients from DR screening exemplify the use of virtual review for VA/OCT data analysis in order to increase throughput. 30 "M1" is a category of patients with maculopathy felt to have disease which merits referral from the diabetic retinopathy screening service.…”

“…30,34 New patient OCT triage, such as those from fast-track nAMD referrals or M1-graded patients from DR screening exemplify the use of virtual review for VA/OCT data analysis in order to increase throughput. 30 "M1" is a category of patients with maculopathy felt to have disease which merits referral from the diabetic retinopathy screening service. Patients with "M1" disease have: exudate within 1 disc diameter (DD) of the centre of the fovea OR a group of exudates within the macula OR any microaneurysm or haemorrhage within 1DD of the centre of the fovea only if associated with a best VA of 6/12.…”