• Telemedicine for Management of Wet AMD

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, September 2019

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    The success of anti-VEGF pharmacotherapy has revolutionized the manage­ment of exudative age-related macular degeneration (AMD), but the need for frequent injections has caused sub­stantial medical and social burdens. To address these issues, the Mayo Clinic in Rochester, Minnesota, established a practice model in which stable patients with wet AMD who had to travel a con­siderable distance could be managed by one of two local ophthalmologists, under the guidance of a retina specialist in Rochester. Starr et al. reported the clinic’s experience with electronic com­munication between the clinicians and concluded that the telemedicine system proved effective for managing patients with exudative AMD.

    For this study, the authors reviewed medical records of all patients who received electronic consultation for the management of exudative AMD at the clinic from September 2015 through August 2017, which included monthly anti-VEGF injections. E-consults were conducted by the retina specialist, and office exams were done by a compre­hensive ophthalmologist, who also provided follow-up care. Collected data included the specialist’s recommenda­tions for intravitreal agent, interval be­tween injections, number of injections, and follow-up schedule.

    During the study period, 200 e-con­sults were performed (for 83 eyes of 59 patients), 198 of which were completed. The mean age of patients at the time of e-consult was 82.3 ± 7.3 years, and the mean follow-up period was 2.4 ± 0.81 years. The mean distance from the pa­tient’s home to the retina specialist was 70 ± 44 miles. Visual acuity was stable throughout the study period, and no patient was lost to follow-up. Only 14 consults (7%) did not comply with the recommendations of the specialist. In most cases, this was due to scheduling errors/conflicts or to comorbidities that resulted in missed appointments.

    The authors concluded that, in select patients and settings, telemedicine may be a viable option for screening and managing patients with wet AMD. They emphasized that a successful retina tele­medicine service requires support from a large health system network with ex­cellent communication and the ability to share electronic data seamlessly.

    The original article can be found here.