Each month, 22 individuals in the United Kingdom lose vision because of hospital-initiated system delays, the Royal College of Ophthalmologists has estimated.1 One potential solution to this dilemma: a cloud-based referral platform that was designed to improve communication between ophthalmologists and other providers and promote rapid triage.
The platform, developed by London-based Big Picture Medical, was put to the test in a pilot study involving three U.K. optometry offices and Moorfields Eye Hospital in London. The result: Of 103 patients initially classified into the referral pathway, 54 (52%) did not need to be referred to a specialist, 35 (34%) could be handled with a routine referral, and 14 (13.6%) needed urgent care.2
For each case, it took the referring optometrist approximately 9 minutes to gather and send the pertinent clinical data—and it took the ophthalmologist an average of 3 minutes to review and triage the case.
OCT MORPHOLOGY. This patient had all three risk factors at baseline—DRIL, HRF, and EZ disruption.
Study rationale. “This study was the first of many steps taken to offer a more streamlined approach to eye care—a digital first encounter that may take the form of asynchronous telemedicine in a store-and-forward model—where a clinical history, eye scans, and visual fields may be reviewed remotely by a relevant specialist,” said Dawn A. Sim, MBBS, FRCOphth, PhD, at Moorfields.
And while the study was conducted with referring optometrists, the platform could be put into place with general practitioners and urgent care facilities.
Well-suited to ophthalmology. The platform lends itself to “subspecialty areas with chronic diseases such as medical retina and glaucoma, which form a large proportion of outpatient consultations,” Dr. Sim said.
In addition, it opens the door to synchronous telemedicine, she said, “in the form of video consultations with the patient at home or with doctors from the emergency department with the aid of a slit-lamp attachment.” This could be useful for oculoplastic and strabismus patients, she said.
“Diagnostic drift” over time. The study has now been running for two years and currently includes nine optometry practices, Dr. Sim said. “The diagnostic drift of different eye conditions that were being referred demonstrates the efficacy of this shared learning [once it is] embedded into a referral workflow.”
For example, she said, during the first year, most referrals were for suspected wet age-related macular degeneration. This shifted in the second year, when patients who had a wider variety and complexity of conditions were referred in.
Next steps. “Working with cloud-based telemedicine platforms has moved this field forward in ophthalmology” as the approaches aim to be “truly device-agnostic,” Dr. Sim said. But while that represents improvement, real progress will depend upon electronic health records systems and major hardware vendors “opening their APIs and paying more than lip service to DICOM compliance,” she said.
And a COVID-19 note. The current pandemic “has forced our hand in changing how we practice ophthalmology,” Dr. Sim said. “In this digital age of high-definition eye scans, mobile devices, and high-speed networks, we must convince commissioners and insurers that specialist care does not always have to involve a slit-lamp exam.”
1 www.rcophth.ac.uk/wp-content/uploads/2019/01/RCOphth-A4-Census-Infographic.pdf. Accessed March 17, 2020.
2 Kern C et al. Br J Ophthalmol. 2020;104:312-317.
Relevant financial disclosures—Dr. Sim: Big Picture Eye Health: C.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Busch None.
Dr. Li Wuhan Neurophth Biotechnology: S.
Dr. Mansouri Alcon: L, Allergan: C,L; Bayer: S; Implandata: C; Glaukos: S; Novartis: L; New World Medical: C,L; Optovue: L,S; Santen: L,S; Sensimed: C; Thea: L; Topcon: L,S.
Dr. Sim Allergan: C; Bayer: C; Big Picture Eye Health: C; Haag Streit: C; Novartis: C.
||Consultant fee, paid advisory boards, or fees for attending a meeting.
||Employed by a commercial company.
||Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
||Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
||Patents and/or royalties for intellectual property.
||Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.
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