July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Development of Teleophthalmology services in the United Kingdom using a cloud-based virtual referral clinic for retinal disease
Author Affiliations & Notes
  • Dawn A Sim
    Moorfields Eye Hospital, London, United Kingdom
  • David Barker
    Rawlings Opticians, London, United Kingdom
  • Pearse Keane
    Big Picture Eye Health, Sydney, New South Wales, Australia
  • Tom McKinnon
    Big Picture Eye Health, Sydney, New South Wales, Australia
  • Karsten Ulrich Kortuem
    Moorfields Eye Hospital, London, United Kingdom
  • Footnotes
    Commercial Relationships   Dawn Sim, None; David Barker, None; Pearse Keane, None; Tom McKinnon, None; Karsten Kortuem, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 4623. doi:
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      Dawn A Sim, David Barker, Pearse Keane, Tom McKinnon, Karsten Ulrich Kortuem; Development of Teleophthalmology services in the United Kingdom using a cloud-based virtual referral clinic for retinal disease. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4623.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To examine a virtual imagin, and cloud-based approach for retinal referrals from community optometrists.

Methods : Virtual referrals from 3 optometry practices were included. A structured history, colour fundus, and optical coherence tomography images were obtained by Optometrists. A virtual referral was made if there was a potential referral or query about retinal imaging findings, using Big Picture Eye Health (Sydney, Australia) cloud-based platform. All scans were reviewed remotely within 48 hours by a consultant Ophthalmologist. Clinical parameters and virtual consults resulting in a referral were analysed. In addition to mandatory structured clinical history fields, the optometrist could enter “Free-text”. This was examined whether a diagnosis suggested and if there was a double entry from structured fields. Associations between all structured fields, free-text analyses, and referral outcome were tested.

Results : 80 eyes of 40 patients were included. 24 patients (60%) did not require a referral to the eye clinic, 32.5% required referral within 18 weeks, and 7.5% within 4 weeks. A greater proportion of patients younger 60 years required referral into hospital 22.5% verses 15% (of all referrals), compared to those older than 60 years (20% verses 45% respectively). The mean visual acuity (VA) of all patients was 20/50 and of those with a VA of better than 20/40 (n=13), 9 patients did not require a referral. The most common diagnosis of patients who did not require a referral was dry age-related macular degeneration (12/24, 50%) Of those referred, there were a variety of diagnoses. The most common was: suspicion of wet age-related macular degeneration, followed by glaucoma, and choroidal mass lesion. The majority of patients were asymptomatic (31/40, 77.5%). Of the 9 who were symptomatic, 2 were referred. Analyses of free-text revealed that a diagnosis was suggested for the majority of patients (36/40, 90%). Free-text doubling occurred in 40% of all cases.

Conclusions : In this pilot community virtual referral clinic, we demonstrated that 60% of referrals to the eye clinic could be seen using a teleophthalmology approach. In the face of diminishing resources in the public health sector, such collaborative care approaches will likely be important to ensure sufficient capacity in hospital eye services for patients who require treatment.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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