While still a point of debate in certain circles, telemedicine is steadily gaining acceptance in eye care, as studies have indicated this approach can reduce costs and wait time, detect disease earlier and identify patients who would have otherwise slipped through the cracks. A new investigation looking at a joint optometrist/ophthalmologist glaucoma telemedicine program in Canada found that a shared-care approach offers glaucoma suspects and medically stable patients with the condition the convenience of shorter travel and wait times, in addition to the continuity of one provider.
The study looked at participating optometrists and ophthalmologists who worked together in a program called Care1, a full-scope, shared-care teleglaucoma model. The investigators suggest the prototype is less expensive than typical online medical visit platforms that require the addition of equipment and personnel, since these elements are already built into optometrists’ practices.
In Care1, patients are screened for glaucoma by their optometrist, who collects all clinical and diagnostic testing data and then uploads it to a shared online platform where remote ophthalmologists review it.
“This full-scope, shared-care model benefits patients with reduced time and travel burden as well as increased continuity of care, optometrists with retention of more of their patients and ophthalmologists with reduced volume burden,” the researchers wrote in their paper.
The study looked at the results of this arrangement from 2016 to 2017, where optometrists located in high-demand locations in two Canadian provinces saw patients in-person, acquired clinical history, performed physical exams, organized diagnostic testing and then uploaded data to a proprietary online platform where they were able to collaborate with participating ophthalmologists to proceed with patient care.
During this period, 4,070 patients received a glaucoma assessment at a Care1 teleophthalmology site. Roughly 97% of participants had a best-corrected visual acuity between 20/20 and 20/40, and about 3% had an IOP greater than 26mm Hg.
An in-person consultation with an ophthalmologist was recommended in about 2% of patients. Additionally, glaucoma patients and suspects represented over half of the patients seen in the Care1 program over the study’s timeframe, highlighting the disease burden in high-demand areas, the study authors noted.
Glaucoma screening was important for many patients in this group, in which 7.7% had a cup-to-disc ratio of at least 0.8, and more than 10% of optometrists found OCT RNFL “red” ratings in the superior and inferior rims.
Shared-care is likely to be an especially important model during and after the COVID-19 pandemic, since social distancing requirements may possibly limit the number of patients who can be seen in-person, and patients may hesitate to visit specialists at their practices until symptoms arise, at which point the opportunity for early screening and intervention has been lost, the investigators suggested.
Elson MJ, Giangiacomo An, Maa AY, et al. Early experience with full-scope shared-care teleglaucoma in Canada. J Glaucoma. June 24, 2021. [Epub ahead of print].