Across the globe, doctors had to quickly pivot their patient care at the start of the pandemic, including UK’s Moorfields Hospital that initially deferred 40,000 glaucoma outpatient appointments and rapidly reconfigured its immediate care approach to higher risk cases. A recent study found this approach—and specifically channeling low-risk individuals to initial phone consults—was successful in catching those with disease progression. The investigation also found the initial telephone consults ensured more individuals showed up to their appointment.
“The provision of timely care to the high volume of glaucoma patients stratified as ‘low risk’ following pandemic-related appointment deferrals continues to prove challenging for glaucoma specialists,” the authors wrote in their paper. “It is unknown whether stratification as ‘low risk’ remains valid over time, raising the potential risk of harm during this period if left unmonitored.”
A total of 639 low-risk glaucoma patients were invited to participate in a “Rapid Glaucoma Assessment Clinic,” which included a brief, advanced telephone history conducted by a clinician. The clinician asked about any new concerns since the last visit, eye drop use, and associated problems. Following the phone consult, these individuals had a follow-up visit in a clinic with an ophthalmic technician who measured their visual acuity and IOP. The study evaluated the clinics’ performance based on the program’s first month of operation, October 2020.
Out of the 639 individuals, 75% attended their booked appointment. Patients who received an initial telephone consultation were less likely to miss their appointment compared with those who didn’t receive a telephone consult (about 14% vs. 29%), which resulted in increased clinic efficiency, the investigators said.
Considering disease progression, the clinics identified 15% of patients as no longer being low risk and expedited follow-up appointments in these cases. Out of this group, approximately 10% of participants required an escalation in treatment following further review.
Additionally, 23 participants were found to have uncontrolled IOP (greater than 30mm Hg) and 12 individuals lost two lines or more of best-corrected Snellen Visual Acuity in either eye since their last appointment.
Also of note: 29 patients required a change or increase in their glaucoma medications, 13 individuals were scheduled for selective laser trabeculoplasty in order to lower IOP, five patients were scheduled for cataract surgery, and three patients were scheduled for glaucoma surgery.
Jayaram H, Baneke AJ, Adesanya J, et al. Managing risk in the face of adversity: design and outcomes of rapid glaucoma assessment clinics during a pandemic recovery. Eye (Lond). August 10, 2021. [Epub ahead of print].