Yang Elizabeth, Rees Amelia, Ahadzi Shantelle, Kanna Yvonne, Schwember Philipp, Henderson Robert, Cruz Lyndon da
Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
Int J Retina Vitreous. 2025 Jun 1;11(1):61. doi: 10.1186/s40942-025-00684-3.
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.
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.
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.
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.
玻璃体黄斑界面（VMI）疾病，包括光学相干断层扫描（OCT）诊断出的视网膜前膜（ERM），在向玻璃体视网膜（VR）外科医生进行的择期转诊中占很大比例。亲自拜访临床医生需要出行、等待、进行检查，然后与外科医生进行交流，这在大型机构中效率低下。我们报告了一项VR虚拟服务的试点研究，通过该服务可以更高效地对这些患者进行评估、检查、安排手术或安排出院。
这是一项前瞻性观察性研究，比较虚拟评估与标准面对面诊所的结果。所有纳入的患者均由验光诊所转诊，其黄斑OCT诊断为ERM。第一项试点研究包括79名患者，他们前往配备有眼科培训技术人员的诊断中心。记录简短病史、视力和眼压。采集广角彩色照片和黄斑OCT图像。由经过培训的眼科医生和高级护士在一周内对病例进行异步评估，在与患者进行电话咨询后，记录虚拟管理计划。所有患者在1周后参加面对面预约，之后比较虚拟和面对面管理计划。第二项试点研究包括65名患者，通过相同途径进行，以检验一致性。进行事后分析以确定无需电话咨询即可进行虚拟管理决策的患者群体。
ERM在本研究的总体择期转诊中占35%。在试点1中，42%的患者通过虚拟评估出院，与面对面评估结果高度一致（阳性预测值 = 89%）。有3例视网膜裂孔漏诊，1例假性OCT诊断。在第二项试点研究中，43%的患者通过虚拟评估出院，出院一致性更高（阳性预测值 = 93%）。该试点研究中未出现周边病变漏诊和误诊情况。
我们的虚拟模式展示了一种无需面对面诊所即可管理和安排患者出院的安全有效方法。这特别适用于诸如ERM等低风险疾病，这类疾病在转诊中占很大比例。
