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Jonathan C. Clarke, Renata A. Puertas, Keith Barton; Identification And Subsequent Clinical Outcomes Of A Patient Population Suitable For A Technology Led, Remote Glaucoma Assessment System. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1419.
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New electronic patient records and networkable imaging and perimetry instruments allow for sufficient data acquisition to remotely assess patients diagnosed with stable glaucoma and ocular hypertension. We investigate whether this system is applicable to a large, adult, mixed office population and explore the implications for service provision.
We defined the clinical criteria required to enter a stable review system and audited the proportion of patients meeting these criteria from the current office population. This subset was then prospectively assessed with perimetry, optic disc imaging and fundus photography. Additional clinical examination was performed for future comparison with a remote assessor. The presence of a new clinical diagnosis and poorly controlled or progressive glaucoma was the primary outcome. Patients were asked for their views of the new potential system and a comparative cost assessment was made.
Eight hundred and seventy one patients’ clinical records were reviewed. Of these 286 (32 %) met the inclusion criteria for the study and 217 were recruited. Underlying diagnosis was: glaucoma n=116 (54%), ocular hypertension n= 63 (29%) and glaucoma suspects n= 38 (17%). Twenty four (11%) patients were identified as having poorly controlled glaucoma and required additional treatment. New and significant diagnosis were identified in 35 (16%) of patients of which 14 (40%) were visually significant cataract. Patient satisfactions levels were high, with 73% stating it represented and improved experience compared to the standard office care. This was achieved with a marginal increase in cost.
In a high volume, resource limited environment new models of care are required. Within a general, adult office glaucoma population, a reasonable proportion would be suitable for review by a technology led, remote assessment system. There would need to be sufficient sensitivity to identify poor glaucoma control and additional diagnosis of which cataract is the most likely. Separation of data acquisition and clinical decision making may allow for an improved patient experience and increased volume of patients assessed by an individual clinician.
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