June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Making telemedicine services a reality in eye care, cloud-based referral platform in ophthalmology – 2 years on.
Author Affiliations & Notes
  • Dawn A Sim
    Medical Retina, Moorfields Eye Hospital, Carshalton Beeches, Surrey, ENGLAND, United Kingdom
    UCL Institute of Ophthalmology, United Kingdom
  • Dun Jack Fu
    Medical Retina, Moorfields Eye Hospital, Carshalton Beeches, Surrey, ENGLAND, United Kingdom
  • Josef Huemer
    Medical Retina, Moorfields Eye Hospital, Carshalton Beeches, Surrey, ENGLAND, United Kingdom
  • Tom McKinnon
    Big Picture Medical Ltd, United Kingdom
  • Footnotes
    Commercial Relationships   Dawn Sim, Big Picture Medical (C); Dun Jack Fu, None; Josef Huemer, None; Tom McKinnon, Big Picture Medical (I)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 5315. doi:
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      Dawn A Sim, Dun Jack Fu, Josef Huemer, Tom McKinnon; Making telemedicine services a reality in eye care, cloud-based referral platform in ophthalmology – 2 years on.. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5315.

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

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Abstract

Purpose : To assess the clinical utility and diagnostic drifts of a cloud-based referral platform for referrals from community optometrists and hospital-based eye care services.

Methods : Retrospective cohort study conducted at Moorfields Eye Hospital, Croydon (NHS Foundation Trust, London, UK). Patients referral into the hospital eye service referral pathway by nine contributing optometrists covering a population of 90 000 individual were analysed (January 2018 to December 2019). Main outcome measures were the analysis of diagnostic entities, and the diagnostic drifts of referrals over the 2-year period.

Results : A total of 203 referrals were analysed retrospectively. In 2018, a total of 98 patients were reviewed; 83.7% were graded as having none, mild, or moderate diagnoses and 16.3% were graded as acute diagnoses/requiring referral and timely appointments in hospital eye services. 2019 saw a total of 105 patients seen in community optometry practices who were referred using the cloud-based referral pathway. A reduction of patients none or mild/moderate eye conditions was observed (71.4%), and an increase in acute diagnoses and those requiring referral referrals to 28.6%. Notably, a marked changed was observed in “potential” wet age-related macular degeneration referrals, that were reduced from 42% to 31% from 2018 to 2019. Sight-threatening diabetic eye disease, the second most common reason for referral, was largely unchanged, from 25.4% in 2018 to 20/5% in 2019. There was an increase in “other” pathologies being referred; 32.6% (2018) to 48.5% (2019). The latter included more complex pathology and ranged from conditions such as previously undetected pattern dystrophies to urgent referrals such as papilloedema.

Conclusions : Diagnostic drifts are a reality in telemedicine-based referral pathways and should play a role in the maintenance of a high quality and safe systems. Continual audits of high quality, structured, and linked clinical and imaging data will facilitate early and accurate diagnoses; imperative if treatment is to be effective. These data may further contribute to the development of robust analytical models to develop a methodology for further understanding of drift detection and characterization in the field of healthcare.

This is a 2020 ARVO Annual Meeting abstract.

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