Assessing the Utility and Patient Satisfaction of Virtual Retina Clinics During COVID-19 Pandemic

Figures & data

Figure 1 Illustrative diagram of the clinical pathways followed by patients in this study and our retina unit in the Department of Ophthalmology at Donostia University Hospital. The arrows show possible outcomes of the clinics.

Figure 2 Donostia University Hospital VRC photograph. All the equipment is in the same room and the patient only has to move once.

Table 1 Adapted SERVQHOS Scale on the Perceived Quality of Hospital Care

Rated on a 10-Point Scale (Mean±SD)	VRC	F2F Clinic
Kindness	9.8 ± 0.5	9.1 ± 1.3
Personalized treatment	9.8 ± 0.5	9.1 ± 1.3
Confidence	9.8 ± 0.5	9.1 ± 1.3
Technology	9.7 ± 0.5	8.9 ± 1.4
Punctuality	9.7 ± 0.6	7.7 ± 2.1
Global satisfaction	9.8 ± 0.4	9 ± 1.5
Did it last more or less time than you expected?	N (%)	N (%)
More	25 (5)	79 (16)
Less	193 (40)	57 (12)
As expected	183 (38)	174 (36)
Did not answer	80 (17)	171 (36)
Total	481	481
Waiting time (minutes)	3.5 ± 5.7	24.1 ± 22.2
Time in the clinic consultation (minutes)	16.3 ± 7.5	21.7 ± 23.5

Abbreviations: SD, standard deviation; VRC, virtual retina clinic; F2F, face-to-face.

Table 2 Patient Characteristics in the Whole Sample and in the Sample with Repeat Blind Assessment

	Total Patients n= 481	Patients with Repeat Blind Assessment n= 114
Sex – n (%)
Males	220 (45.7)	67 (58.7)
Females	261 (54.2%	47 (41.2)
Age (years)
Mean ± SD	67 ± 13.9	65.6 ± 9.9
Range	18–97	43–85
Retinal disease
Mild-to-moderate non-proliferative diabetic retinopathy	146 (30.3%)	49 (42.9%)
Dry age-related macular degeneration	105 (21.8%)	18 (15.7%)
Epiretinal membrane	58 (12%)	10 (8.7%)
Hydroxychloroquine retinopathy screening	54 (11.2%)	6 (5.2%)
Retinal vein occlusion	35 (7.2%)	13 (11.4%)
Choroidal nevus	18 (3.7%)	3 (2.6%)
Central serous chorioretinopathy	16 (3.3%)	8 (7%)
Vitelliform lesions	6 (1.2%)	-
Others: Toxoplasma scar, macular telangiectasia	43 (8.9%)	7 (6.1%)
Outcomes
Face-to-face clinic referrals	93 (19.3%)	25 (21.9%)
Discharged patients	32 (6.6%)	8 (7%)
Continue in virtual retina clinic	356 (74%)	81 (71%)

Table 3 Outcomes of Retina Virtual Clinic Appointments Classified by Disease

Patient Outcome		DR	AMD	ERM	HCQ Retinopathy Screening	RVO	Choroidal Nevus	CSC	Vitelliform Lesions	Others: Toxoplasma Scar, Macular Telangiectasia	Total
Referred to F2F clinic	n	39	22	8	2	4	2	5	1	10	93
	(%)	27%	21%	14%	4%	11%	11%	31%	17%	23%	19%
Discharged	n	16	6	2	3					5	32
	(%)	11%	6%	3%	6%					12%	7%
Continue in VRC	n	91	77	48	49	31	16	11	5	28	356
	(%)	62%	73%	83%	91%	89%	89%	69%	83%	65%	74%
Total		146	105	58	54	35	18	16	6	43	481

Abbreviations: F2F, face-to-face; VRC, virtual retina clinic; DR, diabetic retinopathy; AMD, age-related macular degeneration; ERM, epiretinal membrane; HCQ, hydroxychloroquine; RVO, retinal vein occlusion; CSC, central serous chorioretinopathy.

Table 4 Reasons for Face-to-Face Clinic Referrals

Reason	n (%)
Disease progression	57 (61.2)
Patient deemed unsuitable	21 (22.5)
Other symptoms	8 (8.6)
Poor image quality	4 (4.3)
Patient preference for F2F	3 (3.2)
Total	93 (100.0)

Abbreviation: F2F, face-to-face.

Table 5 Outcomes of Repeat Blind Assessment – Sensitivity of Retina Virtual Clinic to Detect Progression

		Face-to-Face Clinic
		Positive	Negative	Total
Virtual Retina Clinic	Positive	3	22	25
	Negative	0	89	89
	Total	3	111	114
			95% Confidence Interval
			Lower Limit	Upper Limit
Disease prevalence		2.6%	0.6%	8%
Correctly diagnosed patients		80.7%	72%	87.2%
Sensitivity		100%	31%	96.8%
Specificity		80.1%	71.3%	86.9%
Positive predictive value		12%	3.1%	32.3%
Negative predictive value		100%	94.8%	99.9%
Likelihood ratio for a positive test		5	3.4%	7.3%
Likelihood ratio for a negative test		0.0	-	-

Table 6 Likelihood of Outcomes by Type of Retinal Disease

	Continuation in Virtual Retina Clinic		Referral to Face-to-Face Clinic		Discharge
	OR	p	OR	p	OR	p
Age	0.995	0.563	1.017	0.098	0,98	0.138
Other retinal diseases	1		1
Mild-to-moderate non-proliferative diabetic retinopathy	0.612	0.107	1.413	0.301	1819	0.269
Dry age-related macular degeneration	1.122	0.737	0.791	0.532	1213	0.766
Epiretinal membrane	1.898	0.140	0.514	0.161	0664	0.638
Hydroxychloroquine retinopathy screening	3.718	0.015	0.150	0.015	0815	0.793
Retinal vein occlusion	3.019	0.062	0.431	0.162	–	0.998
Sex (male)	1.148	0.545	0.774	0.306	1272	0.551

Abbreviation: OR, odds ratio.

Note: Bold values indicate statistically significant.