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Vivian Anakwenze, K Balaskas, Tariq Aslam, Yvonne D'Souza, Amy Stone, Romi Chhabra, Sajjad Mahmood; An Imaging Based Virtual Review Model for Rapid Access Assessment of Patients with Macular Disease. The Manchester EMAC service.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4828.
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© ARVO (1962-2015); The Authors (2016-present)
The Manchester Emergency Macular Service (EMAC) is a rapid access pathway through which primary care optometrists and general ophthalmologists can refer patients with suspected urgent macular pathology. The service aims to improve time to assessment enabling more rapid access to treatment for patients with macular disease and thus greater potential for visual improvement. The referral to initial assessment target is a maximum of 48 hours. This study evaluated types of pathology referred and time to first appointment using this model.
During an EMAC appointment patients attending have visual acuity assessment, colour fundus photography and optical coherence tomography (OCT scan). Patients’ images are then reviewed and triaged in a virtual clinic setting. Intravitreal treatment is arranged urgently when indicated in accordance with guidelines from the UK Royal College of Ophthalmologists. This retrospective study reviewed one hundred consecutive cases referred to the EMAC service during September and October 2016. Time to first assessment and disease types referred were evaluated.
The modal number of days from date of referral to EMAC service was 1 day. 61% of patients were seen within 48 hrs. Over the time period reviewed 94% of patients received an appointment within a week. Nearly all patients seen outside 5 working days were due to patients requesting a preferred date due to social circumstances. A range of macular pathology was documented. The most common disease detected was dry age related macular degeneration accounting for 34% of referrals to EMAC. Wet age related macular degeneration was detected in 32%. Less commonly, branch retinal vein occlusion in 10% - of which 40% had foveal involvement. Central serous retinopathy was seen in 5% of patients referred during this period.
The EMAC service model may be easily implemented in ophthalmic units and provides a rapid access route for urgent assessment of macular pathology in a virtual clinic using modern imaging technologies. This enables rapid evaluation by macular specialists and rapid access to intravitreal therapy when indicated.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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