Digital Ophthalmology in the UK – Diabetic Retinopathy Screening and Virtual Glaucoma Clinics in the National Health Service

Abstract

The customary doctor and patient interactions are currently undergoing significant changes through technological advances in imaging and data processing and the need for reducing person-to person contacts during the COVID-19 crisis. There is a trend away from face-to-face examinations to virtual assessments and decision making. Ophthalmology is particularly amenable to such changes, as a high proportion of clinical decisions are based on routine tests and imaging results, which can be assessed remotely. The uptake of digital ophthalmology varies significantly between countries. Due to financial constraints within the National Health Service, specialized ophthalmology units in the UK have been early adopters of digital technology. For more than a decade, patients have been managed remotely in the diabetic retinopathy screening service and virtual glaucoma clinics. We describe the day-to-day running of such services and the doctor and patient experiences with digital ophthalmology in daily practice.

Glaucoma triage system: results of implementing a virtual clinic

“…To tackle system overload, various multidisciplinary collaborations and service delivery innovations have been tested, including telemedicine and virtual clinics, which allow rapid and reliable patient assessment [2] through the efficient usage of consultant time by assuring complementary exams are being performed on schedule, and by organizing their information in a user-friendly platform to ensure rapid decision-making in compliance with up-to-date guidelines. [3] In ophthalmology, many virtual clinics have been established worldwide [4][5][6][7][8][9] to deal with the heavy burden of patient referral and follow-up appointment overload, particularly in glaucoma and retina departments. Kotecha et al [8,10,11] described the development process of a virtual clinic for glaucoma patient follow-up at Moorfields Eye Hospital in London, whereas Trikha et al [12] described using virtual clinics as a triage model for patient prioritization upon glaucoma referral.…”

Nachhaltigkeit in der Augenheilkunde

“…Rezente sowie zukünftige technische Neuerungen wie heimatliche/heimatnahe Augeninnendruckmessungen, detaillierte Überprüfungen der Sehfunktion oder Untersuchungen mittels optischer Kohärenztomographie könnten in Kombination mit neuen Vergütungsmodalitäten ebenfalls Mitigation auf der Ebene von Versorgungsstrukturen und Behandlungspfaden ermöglichen. Dies schließt virtuelle Kliniken zum Screening bei Diabetes oder bei der altersabhängigen Makuladegeneration sowie eine telemedizinische Befundung/Mitbeurteilung von augenärztlichen Befunden ein, die gleichzeitig Doppeluntersuchungen reduzieren und Überweisungen respektive Konsultationen ersetzen können [63][64][65][66].…”

“…In Großbritannien sind virtuelle Kliniken und Screeninguntersuchungen in der Augenheilkunde z. B. im Rahmen des Diabetische-Retinopathie-Screenings, teilweise seit Jahrzehnten etabliert [63] [68]. Vor allem Kongressanreisen mit dem Flugzeug (CO2-Äquivalent: 214 g pro Personenkilometer) erscheinen kritisch, wenn Anreisen auch mit dem PKW (154 g/km) oder der Bahn (29 g/km) möglich sind, auch vor dem Hintergrund, dass sich hybride Kongresse als durchaus erfolgreich erwiesen haben [69][70][71].…”

How glaucoma care changed for the better after the pandemic

“…Streamlining glaucoma care can begin prior to the appointment date by mailing new patient questionnaires to patients for completion at home or making forms available online. When scheduling in-person appointments by telephone, staff may also prescreen new and established patients by collecting a history of present illness, medical and ophthalmic history, medication lists, and other pertinent data [ 27 ▪ , 47 ▪ , 48 ▪ ], and later confirming that no changes have occurred on the appointment day. An online check-in process or self-check-in at a kiosk can help alleviate queues at the office entrance [ 27 ▪ ].…”

“…The merits of teleglaucoma have been further harnessed during the pandemic through a hybrid model of glaucoma care delivery which combines in-person, technician-driven data collection with subsequent remote review by, or real-time virtual consultation with, a glaucoma specialist [ 15 ▪ , 47 ▪ , 60 ▪ , 61 ▪ , 70 ▪ , 71 ▪ ]. This innovative approach was instituted in the United Kingdom a decade prior to the pandemic in an effort to meet increasing demand for eye care that exceeded capacity within the National Health System (NHS) [ 47 ▪ ]. Kotecha et al described a stable monitoring service that provided hybrid glaucoma care to 1575 low-risk patients (i.e., glaucoma suspects and those with early-to-moderate glaucoma) between March 2014 and April 2015.…”