Optometric Referrals to Retina Specialists: Evaluation and Triage via Teleophthalmology

Abstract

A retrospective noncomparative consecutive case series was conducted to evaluate the clinical outcomes of a novel teleophthalmology program linking optometrists to retina specialists in Alberta, Canada. One hundred seventy-one patients, referred by optometrists via teleophthalmology to a group retina practice between June 2004 and May 2006 underwent stereoscopic, mydriatic digital photography. Images were transmitted to a secure Web server and analyzed by a retina specialist. Diagnosis and recommendations were sent back to the optometrist and, if necessary, patients were referred for additional testing and clinical evaluation. A chart review of all clinical encounters was performed and the data was tabulated. Demographic features, diagnosis, testing, treatment, distance and time traveled by patient, durations between telemedicine referral, teleophthalmology consultation, in-person consultation, testing, and treatment were recorded. One hundred seventy patients were assessed via teleophthalmology for a total of 190 consultations. Eighty-nine patients (52.0%) required conventional in-person consultation with a referral completion success of 92.1% (82 patients). Fifty of these patients underwent additional diagnostic testing including fluorescein angiography (41), optical coherence tomography (14), laboratory testing (5), visual fields (2), carotid Doppler ultrasound (2), and ocular ultrasound (2). Twenty-five patients required surgical or medical treatment including focal argon laser (10), photodynamic therapy (8), panretinal photocoagulation (2), vitrectomy (2), scleral buckle (1), and other procedures (8). Average wait time between telemedicine referral and teleophthalmology review of images by the retina specialist was 1.9 days (maximum = 20 days). For those patients requiring office evaluation, the average wait time between teleophthalmology referral and in-person evaluation was 25.1 days. Twenty-one of the 25 patients (84.0%) requiring treatment underwent examination, testing, and treatment in a single day. When compared to conventional consultation methods, teleophthalmology reduced average travel distance and time by 219.1 km and 2.7 hours, respectively. Teleophthalmology reduced office visits to the retina specialist by 48% while improving the efficiency of clinical examination, testing, and treatment. Patients benefited through reduced travel time and distance.

The geographic distribution of eye care providers in the United States: Implications for a national strategy to improve vision health

“…This indicates that public health interventions that are effective in a context of limited local eye care provider availability or that are able to leverage optometrist availability effectively in areas with limited ophthalmologist availability could be of widespread use in the US as a part of VHI's national vision health strategy. Previous research suggests that public health strategies to increase access to eye care providers through the use of telemedicine and the implementation of "shared care" models of eye care, where eye care is managed jointly by ophthalmologists and optometrists, may hold promise for increasing the use of eye care services in these areas (Au and Gupta, 2011;Banes et al, 2006;Hanson et al, 2008;Kelly et al, 2011;Lee et al, 2007aLee et al, , 2007bLiu and Swanson, 2013;O'Connor et al, 2012;Rein et al, 2011;Taylor et al, 2007;US Department of Health and Human Services, 2010). In order to improve the ability of public health initiatives to respond to the local availability of eye care providers effectively, more research is needed to determine the optimal division of labor between ophthalmologists, optometrists, and other health care providers in the delivery of care that leads to the prevention, early detection, and timely treatment of vision conditions (US Department of Health and Human Services, 2010).…”

Referral patterns of intraocular tumour patients to a dedicated Canadian ocular oncology department

“…The use of postal codes has been previously used in tele-ophthalmology studies to determine distance to a referral facility. 11 All patients evaluated at PMH Ocular Oncology were referred by ophthalmologists. The referral diagnosis was identified from the referral letter and classified as nevus, melanoma, metastasis, haemangioma, other diagnosis, or unknown diagnosis.…”

Improving patient outcomes: role of the primary care optometrist in the early diagnosis and management of age-related macular degeneration

“…40 Visual acuity screening in the community has been judged to be no more effective than usual care in improving visual outcomes. 41 There is evidence that telemedical referrals from optometrists to ophthalmologists, in the form of digital fundus photos or optical coherence tomography (OCT) scans, improve retinal disease management and reduce costs, 42,43 but there has been no study on the effect of telemedical referrals of AMD patients by optometrists. At present, the preferred practice for detecting the onset of AMD and CNV is periodic in-office dilated fundus examination and at-home self-monitoring followed by confirmation by eye-care professionals.…”