Virtual vitreoretinal clinics: a service delivery pathway of the future.

Abstract

Background: Vitreo-macular interface (VMI) disorders, including epiretinal membrane (ERM) diagnosed on optical coherence tomography (OCT), form a significant proportion of elective referrals to vitreoretinal (VR) surgeons. An in-person visit to a clinician involves travelling, waiting, investigations then an interaction with the surgeon, which entails many inefficiencies in a large institution. We report the pilot studies of a VR virtual service where these patients can be more efficiently reviewed, investigated, listed for surgery or discharged.

Methods: This was a prospective observational study comparing the outcomes of a virtual assessment to standard face-to-face clinics. All patients included were referred from optometry practices for ERM diagnosed on macula OCT. A first pilot study comprised 79 patients, who attended a diagnostics centre staffed with ophthalmic-trained technicians. A short history, visual acuity and ocular pressures were recorded. Widefield colour photographs and macular OCT images were acquired. Cases were asynchronously reviewed by trained ophthalmologists and senior nurses within the week, and following a telephone consultation with the patient, a virtual management plan was documented. All patients attended 1 week later for a face-to-face appointment, following which, virtual and face-to-face management plans were compared. A second pilot comprised 65 patients, through the same pathway, to examine consistency. A post-hoc analysis was carried out to identify the cohort of patients who would be suitable for a virtual management decision without a telephone consultation.

Results: ERMs comprised 35% of overall elective referrals in this study. In Pilot 1, 42% were virtually assessed for discharge, with high concordance with face-to-face outcomes (positive predictive value = 89%). There were 3 cases of missed retinal tears, and 1 OCT misdiagnosis. In the second pilot, 43% were discharged virtually, with higher concordant discharge rates (positive predictive value = 93%). There were no missed peripheral pathology and no misdiagnoses in this pilot.

Conclusions: Our virtual model demonstrates a safe and effective way of managing and discharging patients without a face-to-face clinic. This is especially suitable for low-risk conditions such as ERMs, which comprise a large proportion of referrals.