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Virtual glaucoma clinics safe option for many patients
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Researchers suggest that virtual clinics offer a safe, logistically viable option for certain patients with glaucoma due to the low rate of adverse misclassification and the slow progression of most glaucoma, pending regular patient reassessment.
A total of 204 patients from a virtual glaucoma clinic were included in this study. Subsequent face-to-face clinical assessment was completed by a glaucoma consultant or fellow. Proformas were reviewed remotely by one of two additional glaucoma consultants and 12 months later by the clinicians who had undertaken the original clinical examination.
Researchers identified adverse disagreement between face-to-face and virtual review in 7 of 204 cases (3.4%), in which virtual review failed to predict a need to accelerate follow-up identified in face-to-face review.
Misclassification events were rare, according to researchers, at 1.9% of assessments.
The primary diagnoses were: primary open-angle glaucoma (POAG) in 88 patients, primary ocular hypertension in 59 patients, glaucoma suspects in 33 patients, secondary glaucoma in 18 patients, secondary ocular hypertension in four patients and primary angle closure in two patients.
Following face-to-face assessment, 21 patients were identified as being “unstable” and required a change in management, researchers said.
Researchers found that the virtual clinic has low sensitivity at detecting unstable disease. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
Telemedicine is the next frontier in health care, and for good reason. Objective, high-quality ophthalmic imaging is quickly supplementing many aspects of glaucoma care. High-resolution ocular coherence tomography images can be captured in undilated pupils and provide telling information about the retinal and optic nerve changes seen in glaucoma.
Although this study failed to create a fully reliable “virtual clinic,” it does not mean that this concept will not go on to succeed. This study did not use OCT imaging, considered by many to be standard of care in glaucoma management.
In teaching clinics, we many times review all of the clinical data and imaging “remotely” in our office, prior to seeing the patient. It is amazing how much can be discerned from compiling all of the data before the face-to-face exam even begins.
As technologies improve and demand for care balloons, we will be faced with the reality that we must change how we practice. We are not that far away from having our 6-month IOP checks being performed remotely in select glaucoma patients. Progress in imaging technologies, combined with health extenders and video-based patient interactions will create a new clinical landscape borne out of necessity and progress.
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