Gloucester, Gloucestershire, United Kingdom
Purpose: The British Ophthalmological Surveillance Unit published a report in 2017 that highlighted up to 22 patients per month may be losing vision by such delays experienced in hospital eye services (HES) in the UK. This study reports on the development of a virtual clinic, run by ophthalmic technicians, to manage a cohort of patients with diabetic retinopathy (DR) who were being monitored under the HES whose follow up appointments had been delayed.
Methods: Patients under the care of the hospital eye service whose appointment had been delayed to over 12 months were given an appointment in a virtual clinic, in which: 1. Visual Acuity was recorded using LogMAR charts 2. Pharmaceutical mydriasis instilled 3. 2 x 45 degree fields were taken, with 7-fields in eyes with pre-proliferative or proliferative features 4. A macular OCT using the Topcon 2000. Double grading was performed by technicians with an ophthalmologist only giving an opinion when requested.
Results: Over a period of 18 months, 317 patients with delayed follow up appointments were seen in the virtual clinic. Of these 78 (24.6%) were identified as needing follow up review in the HES because they had proliferative DR, severe non-proliferative DR (NPDR) or significant maculopathy that might need treatment in the near future. 183 (57.7%) had moderate NPDR or milder signs of maculopathy that could be followed up in the virtual clinic environment and 55 (17%) were discharged back to annual diabetic eye screening.
Discussion: Trained technicians with clinical oversight can work collaboratively with HES to help manage follow up waiting times by running virtual clinics.
Conclusion: Monitoring patients who can be routinely followed up in a virtual clinic creates available appointments in the HES for those who need to be seen by an ophthalmologist and highlights those who need to be seen urgently for treatment.