Danish Teleophthalmology Platform Reduces Optometry Referrals into the National Eye Care System

Overview

Journal BMJ Open Ophthalmol

Specialty Ophthalmology

Date 2021 Apr 1

PMID 33791435

Citations 6

Authors

Danson Vasanthan Muttuvelu

Heidi Buchholt

Mads Nygaard

Marie Louise Roed Rasmussen

Dawn Sim

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of this study was to evaluate the stratification of follow-up and referral pathways after implementation of a systematic cloud-based electronic-referral teleophthalmological service for optometry-initiated ocular posterior segment disease referrals to the Danish national eye care system.

Methods And Analysis: A retrospective cohort study was conducted in the period from 1 August 2018 to 31 July 2019. Patients with suspected ocular posterior segment disease reviewed by the telemedical ophthalmology service were included. The service stratified patients into the categories: no need for follow-up, follow-up by optometrist, follow-up by the telemedical service and referral to the national Danish eye care service.

Results: From a pool of 386 361 customers, 9938 patients were enrolled into this study. 19.5% of all patients were referred to the Danish national eye care system, while 80.5% of the patients in the telemedical service were not, in the period from 1 August 2018 to 31 July 2019. 14.4% of the optometrist referrals did not need any follow-up, while a majority of 66.1% needed some follow-up either by the optometrist themselves or within the telemedical service.

Conclusion: Optometrist posterior segment disease referrals can be considerably reduced with a risk stratified approach and optimal use of technology. New models can improve and streamline the healthcare system.

Citing Articles

The Impact of the COVID-19 Pandemic on Tele-ophthalmology-Based Retinal Screening.

Rasmussen M, Cehofski L, Davies J, Faber C, Falk M, Grauslund J Ophthalmol Ther. 2024; 13(9):2467-2480.

PMID: 39093386 PMC: 11341501. DOI: 10.1007/s40123-024-01008-8.

Implementing teleophthalmology services to improve cost-effectiveness of the national eye care system.

Jorgensen E, Muttuvelu D, Peto T, Natarajan S, Davies J, Keane P Eye (Lond). 2024; 38(14):2788-2795.

PMID: 38834842 PMC: 11427588. DOI: 10.1038/s41433-024-03156-4.

What are the experiences of teleophthalmology in optometric referral pathways? A qualitative interview study with patients and clinicians.

Patel D, Abdi S, Carmichael J, Balaskas K, Blandford A BMJ Open. 2024; 14(5):e078161.

PMID: 38803257 PMC: 11129051. DOI: 10.1136/bmjopen-2023-078161.

Teleophthalmology and retina: a review of current tools, pathways and services.

Than J, Sim P, Muttuvelu D, Ferraz D, Koh V, Kang S Int J Retina Vitreous. 2023; 9(1):76.

PMID: 38053188 PMC: 10699065. DOI: 10.1186/s40942-023-00502-8.

The effectiveness of interventions for optometric referrals into the hospital eye service: A review.

Carmichael J, Abdi S, Balaskas K, Costanza E, Blandford A Ophthalmic Physiol Opt. 2023; 43(6):1510-1523.

PMID: 37632154 PMC: 10947293. DOI: 10.1111/opo.13219.

References

Bodnar Z, Schuchard R, Myung D, Tarver M, Blumenkranz M, Afshari N . Evaluating New Ophthalmic Digital Devices for Safety and Effectiveness in the Context of Rapid Technological Development. JAMA Ophthalmol. 2019; 137(8):939-944. PMC: 7196315. DOI: 10.1001/jamaophthalmol.2019.1576. View

Sommer A, Tielsch J, Katz J, Quigley H, Gottsch J, Javitt J . Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. 1991; 109(8):1090-5. DOI: 10.1001/archopht.1991.01080080050026. View

Parkins D, Benwell M, Edgar D, Evans B . The relationship between unwarranted variation in optometric referrals and time since qualification. Ophthalmic Physiol Opt. 2018; 38(5):550-561. DOI: 10.1111/opo.12580. View

Lundmark P, Luraas K . Survey of referrals and medical reports in optometric practices in Norway: midterm findings from a 3-year prospective Internet-based study. Clin Optom (Auckl). 2018; 9:97-103. PMC: 6176781. DOI: 10.2147/OPTO.S136510. View

Cameron J, Ahmed S, Curry P, Forrest G, Sanders R . Impact of direct electronic optometric referral with ocular imaging to a hospital eye service. Eye (Lond). 2008; 23(5):1134-40. DOI: 10.1038/eye.2008.196. View

Kern C, Fu D, Kortuem K, Huemer J, Barker D, Davis A . Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care. Br J Ophthalmol. 2019; 104(3):312-317. PMC: 7041498. DOI: 10.1136/bjophthalmol-2019-314161. View

Bloch S, La Cour M, Sander B, Hansen L, Fuchs J, Lund-Andersen H . Predictors of 1-year visual outcome in neovascular age-related macular degeneration following intravitreal ranibizumab treatment. Acta Ophthalmol. 2011; 91(1):42-7. DOI: 10.1111/j.1755-3768.2011.02268.x. View

Schlegl T, Waldstein S, Bogunovic H, Endstrasser F, Sadeghipour A, Philip A . Fully Automated Detection and Quantification of Macular Fluid in OCT Using Deep Learning. Ophthalmology. 2017; 125(4):549-558. DOI: 10.1016/j.ophtha.2017.10.031. View

Resnikoff S, Felch W, Gauthier T, Spivey B . The number of ophthalmologists in practice and training worldwide: a growing gap despite more than 200,000 practitioners. Br J Ophthalmol. 2012; 96(6):783-7. DOI: 10.1136/bjophthalmol-2011-301378. View

10.

Shah R, Edgar D, Rabbetts R, Blakeney S, Charlesworth P, Harle D . The content of optometric eye examinations for a young myope with headaches. Ophthalmic Physiol Opt. 2008; 28(5):404-21. DOI: 10.1111/j.1475-1313.2008.00587.x. View

11.

Baker H, Ratnarajan G, Harper R, Edgar D, Lawrenson J . Effectiveness of UK optometric enhanced eye care services: a realist review of the literature. Ophthalmic Physiol Opt. 2016; 36(5):545-57. DOI: 10.1111/opo.12312. View

12.

De Fauw J, Ledsam J, Romera-Paredes B, Nikolov S, Tomasev N, Blackwell S . Clinically applicable deep learning for diagnosis and referral in retinal disease. Nat Med. 2018; 24(9):1342-1350. DOI: 10.1038/s41591-018-0107-6. View

13.

Rathi S, Tsui E, Mehta N, Zahid S, Schuman J . The Current State of Teleophthalmology in the United States. Ophthalmology. 2017; 124(12):1729-1734. PMC: 6020848. DOI: 10.1016/j.ophtha.2017.05.026. View

14.

Kern C, Kortuem K, Hamilton R, Fasolo S, Cai Y, Balaskas K . Clinical Outcomes of a Hospital-Based Teleophthalmology Service: What Happens to Patients in a Virtual Clinic?. Ophthalmol Retina. 2019; 3(5):422-428. DOI: 10.1016/j.oret.2019.01.011. View

15.

Todd D, Bartlett H, Thampy R, Dhawahir-Scala F, Wilson H, Tromans C . Agreement in clinical decision-making between independent prescribing optometrists and consultant ophthalmologists in an emergency eye department. Eye (Lond). 2020; 34(12):2284-2294. PMC: 7785022. DOI: 10.1038/s41433-020-0839-7. View

16.

Dobbelsteyn D, McKee K, Bearnes R, Jayanetti S, Persaud D, Cruess A . What percentage of patients presenting for routine eye examinations require referral for secondary care? A study of referrals from optometrists to ophthalmologists. Clin Exp Optom. 2015; 98(3):214-7. DOI: 10.1111/cxo.12255. View

17.

Davey C, Green C, Elliott D . Assessment of referrals to the hospital eye service by optometrists and GPs in Bradford and Airedale. Ophthalmic Physiol Opt. 2010; 31(1):23-8. DOI: 10.1111/j.1475-1313.2010.00797.x. View

18.

Kolko M, Horwitz A, Thygesen J, Jeppesen J, Torp-Pedersen C . The Prevalence and Incidence of Glaucoma in Denmark in a Fifteen Year Period: A Nationwide Study. PLoS One. 2015; 10(7):e0132048. PMC: 4504501. DOI: 10.1371/journal.pone.0132048. View

19.

Sundling V, Gulbrandsen P, Bragadottir R, Bakketeig L, Jervell J, Straand J . Optometric practice in Norway: a cross-sectional nationwide study. Acta Ophthalmol Scand. 2007; 85(6):671-6. DOI: 10.1111/j.1600-0420.2007.00929.x. View

20.

Swystun A, Davey C . Exploring the effect of optometrist practice type on NHS funded sight test outcome. J Optom. 2020; 14(1):69-77. PMC: 7752959. DOI: 10.1016/j.optom.2020.03.008. View