Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Department of Ophthalmology, West Los Angeles Veterans Health Administration, Los Angeles, California, USA.
Telemed J E Health. 2021 Aug;27(8):898-904. doi: 10.1089/tmj.2021.0118. Epub 2021 Jul 12.
The Veterans Health Administration (VHA) has an existing teleretinal screening program that uses nonmydriatic fundus photography to screen for diabetic retinopathy in primary care clinics. Concurrently, optical coherence tomography (OCT) has become a routine screening modality in eye clinics for the diagnosis and management of retinal diseases. This study aimed to evaluate the first year of a pilot tele-OCT program that used existing resources within the VHA. Without the tele-OCT program, all patients would have been referred to retina clinic for an in-person evaluation. This is a retrospective chart review study of patients evaluated by a retina specialist through asynchronous tele-OCT evaluation in 2019. Electronic medical records were used to assess patients' demographic and clinical characteristics, tele-OCT consult results, and patient adherence to tele-OCT follow-up plans. There were 158 tele-OCT consults originating from optometry and nonretinal ophthalmology clinics in 2019. After tele-OCT evaluation, 113 (71.5%) patients were recommended to be monitored in their originating eye clinic, 27 (17.1%) were referred to intravitreal injection clinic, and 12 (7.6%) were referred to retina clinic for in-person evaluation. Patient adherence to tele-OCT follow-up plans was 76.4%. Patients with decreased central vision ( = 0.007) and patients referred to intravitreal injection clinic ( = 0.043) were most adherent to follow-up. The tele-OCT program reduced unnecessary in-person clinic visits and enabled more retina clinic availability. Follow-up adherence was greatest among symptomatic patients and those requiring treatment. Tele-OCT can extend tertiary care resources and improve patient care in a large multidisciplinary eye care practice.
退伍军人健康管理局 (VHA) 拥有现有的远程视网膜筛查计划，该计划使用非散瞳眼底摄影术在初级保健诊所筛查糖尿病性视网膜病变。同时，光学相干断层扫描 (OCT) 已成为眼科诊所用于诊断和管理视网膜疾病的常规筛查方式。 本研究旨在评估利用 VHA 现有资源开展的远程 OCT 计划的第一年。如果没有远程 OCT 计划，所有患者都将被转诊到视网膜诊所进行面对面评估。 这是一项回顾性图表研究，评估了 2019 年通过异步远程 OCT 评估由视网膜专家评估的患者。电子病历用于评估患者的人口统计学和临床特征、远程 OCT 咨询结果以及患者对远程 OCT 随访计划的依从性。 2019 年共有 158 次远程 OCT 咨询来自验光和非视网膜眼科诊所。远程 OCT 评估后，建议 113 名（71.5%）患者在原眼诊所进行监测，27 名（17.1%）转诊至玻璃体内注射诊所，12 名（7.6%）转诊至视网膜诊所进行面对面评估。远程 OCT 随访计划的患者依从率为 76.4%。中央视力下降的患者（ = 0.007）和转诊至玻璃体内注射诊所的患者（ = 0.043）对随访的依从性最高。 远程 OCT 计划减少了不必要的面对面诊所就诊次数，并增加了视网膜诊所的可用性。在有症状的患者和需要治疗的患者中，随访依从性最高。远程 OCT 可以扩展三级保健资源，并在大型多学科眼科保健实践中改善患者护理。
