Teleophthalmology with optical coherence tomography imaging in community optometry. Evaluation of a quality improvement for macular patients

Abstract

Simon P Kelly1, Ian Wallwork2, David Haider1, Kashif Qureshi11Ophthalmology Department, Royal Bolton Hospital National Health Service Foundation Trust, Bolton, 2Wallwork Opticians, Salford, UKPurpose: To describe a quality improvement for referral of National Health Service patients with macular disorders from a community optometry setting in an urban area.Methods: Service evaluation of teleophthalmology consultation based on spectral domain optical coherence tomography images acquired by the community optometrist and transmitted to hospital eye services.Results: Fifty patients with suspected macular conditions were managed via telemedicine consultation over 1 year. Responses were provided by hospital eye service-based ophthalmologists to the community optometrist or patient within the next day in 48 cases (96%) and in 34 (68%) patients on the same day. In the consensus opinion of the optometrist and ophthalmologist, 33 (66%) patients required further “face-to-face” medical examination and were triaged on clinical urgency. Seventeen cases (34%) were managed in the community and are a potential cost improvement. Specialty trainees were supervised in telemedicine consultations.Conclusion: Innovation and quality improvement were demonstrated in both optometry to ophthalmology referrals and in primary optometric care by use of telemedicine with spectral domain optical coherence tomography images. E-referral of spectral domain optical coherence tomography images assists triage of macular patients and swifter care of urgent cases. Teleophthalmology is also, in the authors’ opinion, a tool to improve interdisciplinary professional working with community optometrists. Implications for progress are discussed.Keywords: telemedicine, teleophthalmology, innovation, community referral, optical coherence tomography, service evaluation