June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Implementation of teleretinal screening using optical coherence tomography in the Veterans Health Administration: A pilot study
Author Affiliations & Notes
  • Sahar Ashrafzadeh
    Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
    Ophthalmology, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
  • Bradley Gundlach
    Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
    Ophthalmology, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
  • Irena Tsui
    Ophthalmology, Stein Eye Institute, Los Angeles, California, United States
    Ophthalmology, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Sahar Ashrafzadeh, None; Bradley Gundlach, None; Irena Tsui, None
  • Footnotes
    Support  Unrestricted grant from Research to Prevent Blindness given to the Stein Eye Institute
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2440. doi:
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      Sahar Ashrafzadeh, Bradley Gundlach, Irena Tsui; Implementation of teleretinal screening using optical coherence tomography in the Veterans Health Administration: A pilot study. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2440.

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

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Abstract

Purpose : Use of optical coherence tomography (OCT) in optometry and ophthalmology clinics has improved screening for potential retinal diseases and leads to increased retina clinic referrals and patient travel burden. We evaluated the impact of a pilot tele-OCT program offering remote, asynchronous retina specialist consultation on reducing in-person retina clinic visits and on patient adherence to the recommended follow-up plan.

Methods : We performed a retrospective cohort study of all tele-OCT consults originating from optometry and non-retinal ophthalmology clinics in the Greater Los Angeles Veterans Health Administration from January to December 2019. A retina specialist evaluated tele-OCT consults within three days of each consult and recommended patient-specific follow-up plans, including necessity of in-person retina specialist evaluation. Data on patient demographics, consult notes, and eye care visits were collected from electronic medical records. Patient adherence to the follow-up plan, defined as following up at the recommended clinic within twice the recommended time interval, was calculated. Logistic regression analyses were performed to identify factors associated with patient adherence to the follow-up plan.

Results : In 2019, 158 tele-OCT consults were conducted, of which 44.3% of patients were white, 34.8% were Black, and 10.1% were Hispanic/Latino; 97.5% were male; and mean (SD) age was 70.6 (11.3) years. The most common retinal diagnoses were age-related macular degeneration (n=43, 27.2%) and diabetic retinopathy (n=30, 19.0%). After tele-OCT consultation, 113 (71.5%) patients were recommended continued monitoring in their originating eye clinic, 27 (17.1%) were referred to intravitreal injection clinic, 12 (7.6%) to in-person retina clinic, and 6 (3.8%) to another location. Patient adherence to tele-OCT follow-up plans was 76.4%. Compared to non-adherent patients, patients adherent to follow-up plans were more likely to have ocular symptoms (e.g. decreased central vision, metamorphopsia, or scotoma) (OR 3.53, 95% CI 1.57-7.94, p=0.002) or an intravitreal injection clinic referral (OR 4.61, 95% CI 1.04-20.46, p=0.043).

Conclusions : A tele-OCT program improved clinic efficiency when implemented in a large multidisciplinary eye care practice. Having ocular symptoms or requiring treatment led to patient adherence to tele-OCT follow-up plans.

This is a 2021 ARVO Annual Meeting abstract.

 

Tele-OCT Consult

Tele-OCT Consult

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