Optometry‐facilitated teleophthalmology: an audit of the first year in Western Australia

IMPORTANCE Glaucoma is a common cause of visual impairment in the Veterans Affairs (VA) health care system, but to our knowledge, no data exist concerning tertiary glaucoma care (ie, laser and filtering surgery). OBJECTIVE To determine whether the rate of tertiary glaucoma care differs among veterans cared for through the 4 different eye care delivery models that are present in the VA: optometry-only clinics, ophthalmology-only clinics, clinics with optometry and ophthalmology functioning as a single integrated clinic with ophthalmology as the lead, and clinics with optometry and ophthalmology functioning as separate clinics. DESIGN, SETTING, AND PARTICIPANTS In this retrospective review of the Veterans Health Administration Support Service Center database, 490 926 veterans with a glaucoma-related diagnosis received care from 136 VA medical centers during fiscal year 2016. Demographic and baseline clinical factors, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, and Current Procedural Terminology codes, and the rates of glaucoma surgery procedures were extracted from the database. The organizational structure of each VA eye clinic was obtained. Univariate and multivariate regression analyses were performed for log percent for laser peripheral iridotomy (LPI), laser trabeculoplasty (LTP), and filtering surgery. MAIN OUTCOMES AND MEASURES Rates of LPI, LTP, and filtering surgery. RESULTS Of the 490 926 veterans with a glaucoma-related diagnosis, 465 842 (94.9%) were male, 309 677 (63.1%) were white, and 203 243 (41.4%) were aged 65 to 74 years. The rate of LPI was 0.30%, 0.28%, 0.67%, and 0.69% in optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). The rate of LTP was 0.31%, 1.06%, 0.93%, and 0.92% in care delivery models that included optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). The rate of filtering surgery was 0.32%, 0.51%, 0.69%, and 0.60% in optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). Multivariate regression analyses showed that these differences remained significantly different even after adjusting for potential confounders. CONCLUSIONS AND RELEVANCE Disparities exist in the use of tertiary glaucoma services within the VA, and different care delivery models may play a role. Outcomes of glaucoma care for the different models of eye care delivery were not analyzed in this study.

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“…Teleophthalmology has been used in other health care systems that render care to rural patients. 17,18…”

Section: Discussionmentioning

confidence: 99%

Differences in Tertiary Glaucoma Care in the Veterans Affairs Health Care System

Lee

Pieters

et al. 2018

JAMA Ophthalmol

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“…Furthermore, teleophthalmology can provide significant savings in time and travel expenses for patients, which could be the reason why it was mostly preferred by the younger population of patients, who may have busier schedules. Previous studies found good agreement between the diagnosis and management decisions by teleophthalmology compared to the diagnosis and management decisions in eye clinics 2,5,6,11,12. This is mostly because diagnostic imaging and measurements play an important role in ophthalmology4 and these can be easily transferred via telemedicine and help in making a diagnosis or deciding on the suitability of candidates for surgery.…”

Section: Discussionmentioning

confidence: 91%

Informed consent in refractive surgery: in-person vs telemedicine approach

Schallhorn

Hannan²,

Teenan³

et al. 2018

OPTH

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PurposeThe aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion.MethodsPatients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality.ResultsPrior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=0.47). In a multivariate model, the major predictor of patient’s satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon’s approach. The type of consent (remote or in-clinic) had no impact on patient’s perception of consent quality in the regression model.ConclusionThe majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient’s perception of consent quality, regardless of the method of their consent.

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“…A 1-year retrospective audit of a teleophthalmology consulting program of 709 patients in western Australia showed that cataract was the most frequent diagnosis (42.7%) followed by glaucoma (11%), AMD (4.4%), and DR (3.8%). Among diagnoses made at the conclusion of the teleophthalmology consultation, urgent conditions could also be identified, such as external eye trauma, periorbital cellulitis, narrow-angle glaucoma, retinal/vitreous detachment, and retinal artery/vein occlusion [72].…”

Section: Anterior Segmentmentioning

confidence: 99%

Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak

Sommer

Blumenthal

2020

Graefes Arch Clin Exp Ophthalmol

102

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Purpose Technological advances in recent years have resulted in the development and implementation of various modalities and techniques enabling medical professionals to remotely diagnose and treat numerous medical conditions in diverse medical fields, including ophthalmology. Patients who require prolonged isolation until recovery, such as those who suffer from COVID-19, present multiple therapeutic dilemmas to their caregivers. Therefore, utilizing remote care in the daily workflow would be a valuable tool for the diagnosis and treatment of acute and chronic ocular conditions in this challenging clinical setting. Our aim is to review the latest technological and methodical advances in teleophthalmology and highlight their implementation in screening and managing various ocular conditions. We present them as well as potential diagnostic and treatment applications in view of the recent SARS-CoV-2 virus outbreak. Methods A computerized search from January 2017 up to March 2020 of the online electronic database PubMed was performed, using the following search strings: "telemedicine," "telehealth," and "ophthalmology." More generalized complementary contemporary research data regarding the COVID-19 pandemic was also obtained from the PubMed database. Results A total of 312 records, including COVID-19-focused studies, were initially identified. After exclusion of nonrelevant, non-English, and duplicate studies, a total of 138 records were found eligible. Ninety records were included in the final qualitative analysis. Conclusion Teleophthalmology is an effective screening and management tool for a range of adult and pediatric acute and chronic ocular conditions. It is mostly utilized in screening of retinal conditions such as retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration; in diagnosing anterior segment condition; and in managing glaucoma. With improvements in image processing, and better integration of the patient's medical record, teleophthalmology should become a more accepted modality, all the more so in circumstances where social distancing is inflicted upon us.

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Optometry‐facilitated teleophthalmology: an audit of the first year in Western Australia

Abstract: Teleophthalmology is a valuable adjunct to regional outreach ophthalmology services, providing patients with increased access to specialist care for a wide range of ophthalmic conditions, and more efficient access to surgical care.

Cited by 31 publications

References 16 publications

Differences in Tertiary Glaucoma Care in the Veterans Affairs Health Care System

Differences in Tertiary Glaucoma Care in the Veterans Affairs Health Care System

Informed consent in refractive surgery: in-person vs telemedicine approach

Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak

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