Impact of direct electronic optometric referral with ocular imaging to a hospital eye service

Abstract

Aims A study to assess the feasibility, safety, and clinical effectiveness of electronic referralFwith and without imagesFof patients directly from optometrists in primary care to the hospital eye service (HES) in contrast to the traditional paper-based referral, through the general practitioner (GP). Methods Three optometry practices sent consecutive referrals with images through the NHS Net to the HES. The standard General Ophthalmic Service form was electronically redesigned with additional information on patient choice for advice, appointment, or surgery. All paper referrals to the HES from the same three optometry practices before the study period were analysed (control group A) as were all paper referrals from the remaining optometrists in Fife (control group B). Results A total of 346 electronic referrals were received over 18 months. 218 (63%) were classified as requiring and 128 (37%) as not requiring a HES appointment. The latter were subsequently examined with unexpected pathology found in three cases (glaucoma, macular pigment epithelial detachment, and possible peripheral retinal tear). In both groups, the major pathologies reported were macular degeneration, cataract, glaucoma, diabetic retinopathy, and abnormal retinal appearances. A total of 17 (15%) patients in group A and 26 (8.4%) patients in group B were classified as not requiring HES appointment. These control groups indicate that approximately 10-15% of paper referrals are not seen in the HES. To summarise, therefore, 63% of people referred by the optometrist directly using electronic referral (with or without images) were given a HES appointment compared to 85% of people referred through the traditional paper method (without images) through their GP. Conclusion Electronic referral with images to the HES is safe, speedy, efficient, and clinically accurate given some limitations and avoids unnecessary consultation in 37% of referrals.

Teleophthalmology with optical coherence tomography imaging in community optometry. Evaluation of a quality improvement for macular patients

“…Spectral domain ocular coherence tomography (SD OCT) imaging is being used in optometric primary care with referral of SD OCT images to hospital eye services (HES). Collaboration between primary and secondary care in the application of retinal imaging technology in this way, while innovative, is not unique 3,4. However no such previous publications included OCT imaging.…”

The Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual randomised balanced incomplete block trial

“…13,14 Taking and interpreting retinal images are skills that can be easily taught (the former is usually carried out by technicians in the HES) and, therefore, the final evaluation in a telemedicine scenario need not always involve an ophthalmologist. Many of the hospital-based scenarios involve specialist optometrists and nurse practitioners making clinical decisions, although the effectiveness of these management pathways has not yet been formally evaluated.…”

Teleophthalmology in Practice

“…Secondary or tertiary screeners can also undertake remote digital imaging screening. The Central Ophthalmology Receiving Unit in NHS Fife, Scotland reported the benefits of improving use of existing resources to bridge the gap between primary and secondary ophthalmic care (Cameron JR et al, 2009). Hansen C et al, 2008 have described a similar government funded scheme in Alberta and in the Northwest Territories of Canada (www.teleophthalmology.com) which allows remote rural optometrists to transmit fundus photographs to retinal specialists in the regional centre.…”