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Faazil Kassam, Samreen Amin, Enitan Sogbesan, Marianne Edwards, Michael W. Dorey, Ordan Lehmann, Karim F. Damji; Teleglaucoma: Improving Access To And Efficiency For Glaucoma Care. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4490. doi: https://doi.org/.
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Given the ever increasing burden of glaucoma care and human resource capacity constraints, creative solutions are needed for high quality, timely glaucoma assessment and management to prevent visual loss. Teleglaucoma, which adapts telehealth applications for glaucoma, offers the potential to improve access and efficiency, particularly for those in underserviced areas. We describe our experience with 2 such models.
Teleglaucoma has been implemented at the University of Alberta as part of a wider patient-centered collaborative care and teleophthalmology approach. A key component is specialized software that permits stereoscopic views of digital retinal images. The programs operate on a ‘hub and spoke’ construct that remotely transfers structured patient information via capture stations (spokes) to a center for grading (hub).Two pilots have been launched: a ‘remote’ model with 15 community optometrists, and an ‘in-house’ model for urban and semi-urban patients where eligible referrals are worked up by technicians without a physician. Structured history, examination (IOP, CCT, slit-lamp), and diagnostic assessment (fundus photographs, visual fields, OCT, and HRT) are uploaded securely, and grading is completed with a report sent to the referring provider. The goal is to provide earlier access and shorter visits. For the in-house model, access time, visit cycle time, and report turnaround time are monitored. Exclusion criteria include advanced glaucoma and significantly elevated IOP among others.
195 consults have been graded through the remote model since 2008, and 62 consults (25 in-hospital and 37 in-office setting) completed using the in-house model since it began early 2011. At present, average access time for an in-house visit is 42 days (hospital) and 48 days (office) compared to 90-120 days for seeing patients of this type in person. Average cycle time during the visit is 87 minutes in hospital and 90 minutes in office compared to 120 minutes for one of the glaucoma specialists. Average reporting time for both models is 7 days.
Early data suggest our remote and in house teleglaucoma programs can provide expedited access and improved efficiency for glaucoma care. However, more data including scientific validation, satisfaction, cost-effectiveness and comparative effectiveness are needed to ensure teleglaucoma is an effective way to deliver services more commonly.The authors acknowledge teleophthalmology program coordinator Abshir Moalin for support and Pfizer Inc. Canada for an unrestricted startup grant.
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