Danish teleophthalmology platform reduces optometry referrals into the national eye care system

Abstract

ObjectiveThe purpose of this study was to evaluate the stratification of follow-up and referral pathways after implementation of a systematic cloud-based electronic-referral teleophthalmological service for optometry-initiated ocular posterior segment disease referrals to the Danish national eye care system.Methods and AnalysisA retrospective cohort study was conducted in the period from 1 August 2018 to 31 July 2019. Patients with suspected ocular posterior segment disease reviewed by the telemedical ophthalmology service were included. The service stratified patients into the categories: no need for follow-up, follow-up by optometrist, follow-up by the telemedical service and referral to the national Danish eye care service.ResultsFrom a pool of 386 361 customers, 9938 patients were enrolled into this study. 19.5% of all patients were referred to the Danish national eye care system, while 80.5% of the patients in the telemedical service were not, in the period from 1 August 2018 to 31 July 2019. 14.4% of the optometrist referrals did not need any follow-up, while a majority of 66.1% needed some follow-up either by the optometrist themselves or within the telemedical service.ConclusionOptometrist posterior segment disease referrals can be considerably reduced with a risk stratified approach and optimal use of technology. New models can improve and streamline the healthcare system.

Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration

“…The sensitivity of fundus photography (81%) is slightly lower than that of OCT (97.5%), whereas the specificity (89.5%) is slightly higher than that of OCT (85%); however, both are superior to that of the Amsler grid . In some countries, optometry clinics provide posterior segment screening using imaging modalities such as fundus photography or OCT, after which images are interpreted in collaboration with retina specialists . These initiatives bring retinal imaging closer to the patients, allow broader access to better diagnostic methods, and help with triaging patients by urgency …”

“…In some countries, optometry clinics provide posterior segment screening using imaging modalities such as fundus photography or OCT, after which images are interpreted in collaboration with retina specialists . These initiatives bring retinal imaging closer to the patients, allow broader access to better diagnostic methods, and help with triaging patients by urgency …”

Real-Time Mobile Teleophthalmology for the Detection of Eye Disease in Minorities and Low Socioeconomics At-Risk Populations

“…Danish teleophthalmology platform is a good example to overcome this challenge. 36 It was a real-world, large-scale, e-health based teleophthalmologic model. The authors of this study point out the requirement of an e-health model due to the dramatically risen eye care patients and concomitant referral system emergency.…”

“…Danish teleophthalmology platform is a good example to overcome this challenge 36 . It was a real-world, large-scale, e-health based teleophthalmologic model.…”

The effectiveness of interventions for optometric referrals into the hospital eye service: A review

“…For example, in glaucoma care, referral filtering schemes have been implemented to ‘triage’ low‐risk patients by optometrists with higher training and certification 6 through repeating, enhancing or refining the findings from the community eye examination before deciding whether onward referral to the HES is appropriate. More recently, with the advancement of ocular imaging, there has also been a focus on the implementation of teleophthalmology services for asynchronous referral review and triage, which has been shown to reduce the number of unnecessary referrals for retinal disease from entering the HES 7,8 . Furthermore, the significant surge in the development of artificial intelligence (AI) for medical imaging 9,10 has highlighted a potential for its use in a range of applications including eye care.…”