Early Experience With Full-scope Shared-care Teleglaucoma in Canada

Abstract

Précis: Large Canadian full-scope, shared-care teleglaucoma facilitates efficient management and diversion of medically stable patients away from overburdened subspecialty clinics while allowing patients the convenience of shorter travel, shorter wait time, and continuity with one provider. This report shares Care1 protocol, early patient characteristics, and quality data.Purpose: This paper describes early experience with Care1, a large full-scope, shared-care teleglaucoma program. Optometrists located in high-demand locations saw patients in-person, acquired clinical history, performed a physical examination, organized diagnostic testing, then uploaded data to a proprietary online platform where they were able to collaborate with participating ophthalmologists to make plans for patient care.Materials and Methods: The Care1 database was queried for all patients with a diagnosis of glaucoma or glaucoma suspect seen between February 2016 and March 2017. Clinical characteristics like diagnosis, ocular medication history, best-corrected visual acuity, intraocular pressure, cup-to-disc ratios, optical coherence tomography imaging results, and central corneal thickness were collected. Quality metrics studied included rates of referral to an in-person ophthalmologist and consistency of cup-to-disc assessments between in-person optometrists and remote ophthalmologists.Results: A total of 4070 patients received care at a Care1 teleophthalmology site in 2 provinces for glaucoma assessment from February 2016 to March 2017. The population was 55.1% female, and the average age was 57.8 years. Overall, 97.3% of patients had a best-corrected visual acuity between 20/20 and 20/40 and 3.3% had an intraocular pressure > 26. An in-person consultation with an ophthalmologist was recommended for 1.9% of patients. Conclusion:Early experience with this full-scope, shared-care teleglaucoma program in Canada indicates it is a convenient, collaborative model of care for glaucoma suspects, and medically stable glaucoma patients.

Glaucoma and Telemedicine

“…32 More recently, an early experience with Care1, a large full-scope, shared-care teleglaucoma program in Canada, was reported. 33 Optometrists located in high-demand locations saw patients in person, acquired clinical history, performed a physical examination, organized diagnostic testing, then uploaded data to a proprietary online platform where they were able to collaborate with participating ophthalmologists to make plans for patient care. 33 A teleglaucoma initiative was also implemented at a Veterans Affairs Hospital in Pittsburgh, where a pilot study was aimed to evaluate the reliability and efficacy of a remote patient monitoring teleglaucoma initiative in a veteran population.…”

“…For patients with positive screening for glaucoma based on virtual assessment, face-to-face consultation was scheduled, and hypotensive ocular medication started in most cases 32. More recently, an early experience with Care1, a large full-scope, shared-care teleglaucoma program in Canada, was reported 33. Optometrists located in high-demand locations saw patients in person, acquired clinical history, performed a physical examination, organized diagnostic testing, then uploaded data to a proprietary online platform where they were able to collaborate with participating ophthalmologists to make plans for patient care 33…”

Stakeholder perceptions affecting the implementation of teleophthalmology

“…In ophthalmology, telemedicine is well-validated and widely accepted in diabetic retinopathy screening [1], and more recently has found traction in glaucoma monitoring [2][3][4][5], retinopathy of prematurity screening [6,7], macular degeneration screening [8,9], and comprehensive ophthalmology [10]. Increasingly inexpensive and ubiquitous technologies, expanding computational power, and surging demand for limited healthcare resources are all pressures that have contributed its popularity.…”

Letter to the Editor: Early Experience With Full-Scope Shared-Care Teleglaucoma in Canada

“…We have read with interest the paper "Early Experience With Full-scope Shared-care Teleglaucoma in Canada" by Elson et al 1 We found it very relevant to the current literature due to the great global burden of glaucoma and the relevance that telemedicine has taken during the COVID-19 pandemic. The integration of the available technology with the adequate flow of patients will necessarily result in better screening opportunities and will reduce the barriers to access to health care services.…”

“…This is critical in tele-ophthalmology programs like the one reported here, as there is evidence of different adherence rates between patients receiving usual care versus enhanced interventions, not only in glaucoma 3 but also in other diseases such as diabetic retinopathy. 4,5 Studies such as the one carried out by Elson et al, 1 are very important both to analyze the methods currently used in face-to-face practices and to implement and scale up tele-ophthalmology. In this way, a greater reach can be achieved for these promising remote services that are gaining more and more strength.…”