Results From the First Teleglaucoma Pilot Project in Addis Ababa, Ethiopia

Abstract

Precis: A teleglaucoma case-finding model was utilized in Ethiopia using a high-risk case identification approach. An overall 7.9% of patients had definite glaucoma, and 13.8% were glaucoma suspects. Most cases could be managed medically. Background: This study was carried out to analyze disease prevalence and clinical referral pathways for high-risk patients assessed through a hospital-based teleglaucoma case-finding program. Methods: Patients over the age of 35 years were referred from outpatient diabetic and hypertensive clinics. Through a teleglaucoma consultation, a glaucoma specialist provided remote diagnosis and management recommendations. Patient referral pathways were analyzed. Part way through the program, frontline ophthalmic nurses and optometrists were empowered to refer patients to be seen by general ophthalmologists within a week if patients met high-risk criteria. Qualitative stakeholder feedback was also obtained. Results: A total of 1002 patients (53% female) were assessed with a mean age of 51.0±11.7 years. The prevalence of glaucoma and glaucoma suspects was 7.9% (79 cases) and 13.8% (138 cases), respectively. Retinopathy was found in 9.1%, with hypertensive retinopathy (2.7%) and diabetic retinopathy (2.5%) representing the majority of cases. Age-related macular degeneration was present in 1.5% and cataract in 16%. An overall 63% of cases were without organic eye disease. 35% of patients were referred to a general ophthalmologist, 0.7% to a glaucoma specialist (for surgery), 1.5% to a retina specialist, and 17.7% to an optometrist for further care. Qualitative analysis revealed that stakeholders felt the value of teleglaucoma would be in triaging patients requiring more urgent management and in identifying disease at an earlier stage. Conclusions: There is a high prevalence of glaucoma in Ethiopian patients assessed through this teleglaucoma program. This model and study have also demonstrated various principles behind telemedicine, such as the development of an intelligent triage system, case-finding for a variety of diseases, and consideration of optimal patient flow/referral pathways.

The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review

“…Publication dates of all studies included in this review ranged between 1999 and 2020. The location of the studies reviewed include seven studies conducted in Australia, 16 , 30–35 seven in the United States, 29 , 36–41 three in Canada, 42–44 two in India, 45 , 46 two in The Netherlands, 47 , 48 three in the United Kingdom, 49–51 one study was conducted in an undisclosed location, 52 and single studies were conducted in Ethiopia 53 and Spain. 54 …”

“…Prospective study designs represent the largest number of included studies, including four cohort studies 36 , 48 , 53 , 54 and four prospective audits. 31 , 33 , 34 , 49 Other frequently utilized study designs included retrospective audits ( n = 4), 30 , 32 , 35 , 41 interobserver reliability studies ( n = 2), 29 , 37 questionnaires ( n = 3), 16 , 46 , 52 and mixed methods studies ( n = 2).…”

Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak

“…A tele-screening program aimed at glaucoma in Addis Ababa, Ethiopia, concluded glaucoma and glaucoma suspect prevalence to be 7.9% and 13.8%, respectively. Aside from remote diagnosis, patients were also offered remote management and treatment recommendations [ 66 ]. Accuracy and consistency of telemedicine techniques in comparison with the traditional clinical exam were also confirmed in a prospective study of 107 subjects who underwent automated tonometry, measurements of their refractive state, keratometry readings, a non-mydriatic retinal scan, and an OCT, which provided a wealth of information, including measurements of central corneal thickness, angle anatomy, cup/disc ratio, retinal nerve fiber layer distribution, and posterior pole ganglion cell complex data [ 67 ].…”

The Future Is Now: Incorporating Telemedicine into Glaucoma Care

“…Over 35% of patients who were screened were determined to have suspicious optic nerves or ocular hypertension [ 24 , 25 ]. In developing countries with high-risk populations, teleglaucoma screening is similarly able to detect high rates of glaucoma and ocular hypertension, identifying patients who need further care to avoid potentially irreversible vision loss [ 26 ]. Studies such as these suggest an important role for teleglaucoma screening to identify patients at risk for glaucoma who may otherwise go undetected (Table 1 ).…”