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E. sogbesan, C. Rudnisky, M. Tennant, K. F. Damji; Web Based Stereoscopic Teleglaucoma - Early Experience of a Collaborative Care Model. Invest. Ophthalmol. Vis. Sci. 2010;51(13):205.
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To improve access to glaucoma care thorough collaboration with optometrists who have appropriate infrastructure to enable teleglaucoma evaluation.
Using proprietary software that has been validated for diabetic retinopathy assessment, digital stereoscopic disc images, visual fields and retinal/optic nerve imaging from patients who presented to an optometrist were analyzed and graded by a glaucoma specialist. Disc characteristics were evaluated. Fields and other tests were graded as normal, borderline or abnormal. A grading diagnosis was made and recommendations for follow up care provided.Data was extracted from the grading reports, entered into a database and analyzed using EPI info software. The final diagnoses were compared to the referring diagnosis for agreement.
Images and data from 28 patients referred over one year from urban (7%), semi urban (71%) and rural (22%) optometrists were analyzed. The M:F ratio was 2:3 with an average age of 60 (13 - 96yrs).Data and images provided by the optometrists included a brief history, VA, IOP (57% applanation and 30% NCT), CCT (52%), automated visual fields (82%), stereo digital nerve photos (100%) and imaging including HRT (77%) and OCT (4%). Anterior segment exam information was provided in 32% and gonioscopy in 14%.Patients were graded as OAG suspects (32%), definite POAG (25%), NTG (25%), ACG or suspects (7%) and non glaucomatous optic nerve cupping (11%). In approximately 50% of the patients, there was agreement in diagnosis between the referring optometrist and the grader.Only 4 patients (14%) were referred to a glaucoma specialist, an 85% reduction in consultation and this provided significant savings in terms of time of travel (average 4.8 hours /patient). 24 patients (86%) are currently followed by their optometrists and/or managed with glaucoma specialists.
The teleglaucoma model presented can be effectively integrated into existing optometric clinics. This approach reduces the number of referrals and associated patients travel time. There is a need for better standardization of referral information.Improvement in anterior segment assessment by optometrists will enhance teleglaucoma grading and assessment.Acknowledgement: Contributing optometrists and Abshir Moalin
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