A recent telemedicine program for patients diagnosed as glaucoma suspects in the conventional clinic setting has achieved high patient retention, a study found. Significant disease progression was rare with a few patients requiring referrals back to the clinic setting or initiation of therapy.
The Kaiser Permanente Eye Monitoring Center (EMC) began a pilot project in 2013 to monitor low-risk glaucoma suspects. Researchers conducted a retrospective chart review of the 225 patients enrolled in the first two years of the new program.
Unlike other telemedicine programs that have focused on screening for glaucoma, this program took patients who already received a baseline clinical evaluation and provided monitoring. After enrollment, annual follow-ups occurred at a local ophthalmology office, where a technician measured vision, intraocular pressure (IOP), and optical coherence topography (OCT) retinal nerve fiber layer (RNFL) imaging. These findings were forwarded to a trained technician at a centralized telemedicine reading center who would screen and compare them to prior visits.
Only five patients required in-person clinical evaluation due to possible progressive RNFL loss that the EMC noted; of those, only two ultimately required the initiation of glaucoma medications. No patients were referred to the clinic for vision loss or elevated IOP. Of eligible patients, 97.3% attended their one-year follow-up visit and 92.5% attended their two-year follow-up visit. From a survey assessing their satisfaction with the program after their first visit, 87% of patients said that they would be extremely or quite likely to recommend the program to a friend, and more than 80% of patients said that the program was extremely or very helpful, convenient and professional.
Researchers note that early stages of glaucoma are ideal for telemedicine programs because glaucoma is a slowly progressive disease where small incremental progression is less likely to be visually significant in the early phases. They concluded that the EMC could reduce the clinic burden that would have been created by the remaining patients who did not need to be seen in clinic.
|Modjtahedi BS, Chu K, Luong TQ, et al. Two-year outcomes of a pilot glaucoma suspect telemedicine monitoring program. Clin Ophthalmol. 2018; 2018(12):2095-2102.|