Shared Care and Virtual Clinics for Glaucoma in a Hospital Setting

Abstract

Glaucoma patients require lifelong management, and the prevalence of glaucoma is expected to increase, resulting in capacity problems in many hospital eye departments. New models of care delivery are needed to offer requisite capacity. This review evaluates two alternative schemes for glaucoma care within a hospital, i.e., shared care (SC) and virtual clinics (VCs), whereby non-medical staff are entrusted with more responsibilities, and compares these schemes with the “traditional” ophthalmologist-led outpatient service (standard care). A literature search was conducted in three large bibliographic databases (PubMed, Embase, and Trip), and the abstracts from the prior five annual meetings of the Association for Research in Vision and Ophthalmology were consulted. Twenty-nine were included in the review (14 on SC and 15 on VCs). Patients with low risk of vision loss were considered suitable for these approaches. Among the non-medical staff, optometrists were the most frequently involved. The quality of both schemes was good and improved with the non-medical staff being trained in glaucoma care. No evidence was found on patients feeling disadvantaged by the lack of a doctor visit. Both schemes increased the hospital’s efficiency. Both SC and VCs are promising approaches to tackle the upcoming capacity problems of hospital-based glaucoma care.

Three‐year outcomes of an optometrist‐led virtual clinic for new glaucoma referrals

“…Shared‐care and virtual clinic models are gaining in interest as a means of addressing shortfalls in clinician numbers and limited capacity in existing services. A recent global‐focused systematic review by Simons et al 48 found 14 published analyses of SC (in multiple countries) and 15 published analyses of virtual glaucoma services (limited to the United Kingdom) wherein optometrists were used in history taking and clinical assessment, primarily in uncomplicated OHT and suspect cases, with high agreement with clinicians and acceptability to patients, although all models as a rule still used glaucoma clinicians in initial assessment and none implemented optometrists in a lead position in diagnostic or management decision roles. We feel that the Aintree VGC is a valid model that demonstrates optometrists can, with ophthalmic‐specialist support, lead and deliver a virtual clinical glaucoma service safely and effectively leading to expanded capacity in glaucoma services, reduced pressure on outpatient clinics and improved access to timely outpatient care for high‐risk cases, with cost‐saving implications.…”

Cost–utility analysis of commonly used anti-glaucoma interventions for mild-to-moderate primary open-angle glaucoma patients in rural and urban China

“…Second, although the effectiveness and safety of novel anti-glaucoma procedures have been proven, expensive imported devices are a barrier to adoption, and newer and more affordable surgical equipment and procedures are required to meet the growing needs; further, cost-effectiveness analysis to understand whether low-cost devices translate into lower overall costs should be a priority 29. Third, in view of the longer hospitalisation time of patients, shared medical care and virtual medical care policies can help to ensure the intervention effect while reducing the length of stay and subsequent economic burden 30. Fourth, a well-functioning hierarchical blindness prevention and treatment network is the key to managing the full range of glaucoma 1 31.…”

Outcomes of newly referred patients with suspected angle closure: Do we need to redefine the clinical pathways?

“…Although glaucoma virtual clinics are growing in numbers, 5,36 there are no standardised criteria for further assessment in a face-to-face setting. Based on angle width criteria 12 on AS-OCT (an iridocorneal angle of < 20 o , later tightened to < 10 o ), 66% of patients with suspected angle closure in the virtual clinic required further assessment with gonioscopy.…”

“…3 In light of the EAGLE and the ZAP trial data, the clinical pathway for angle closure needs to be revisited, 4 including virtual clinics, which have become increasingly popular to address capacity problems of hospital-based glaucoma care. 5 This is important to reduce variation, improve quality of care, and optimise clinical outcomes. 6 It is also necessary for optimal allocation of healthcare resources, which has become an even greater priority since the outbreak of the COVID-19 pandemic.…”