https://orcid.org/0000-0003-0758-9068
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ABSTRACT
Clinical relevance
Following the COVID-19 lockdown, uptake of slitlamp-enabled live teleophthalmology increased. Its use contributed to a reduction of referrals escalated to secondary care during-lockdown (avoided: 64% pre-lockdown vs 86% during-lockdown).
Background
Live teleophthalmology using video conferencing allows real-time, three-way consultation between secondary care, community providers and patients, improving interpretation of slit lamp findings and potentially reducing referrals to secondary care. NHS Forth Valley implemented live teleophthalmology in March 2019. In March 2020, the COVID-19 pandemic created urgency to deliver ophthalmic care while minimising the risk of contracting or spreading the disease. We aim to compare the uptake and two outcomes (number of avoided secondary care referrals; pattern of presenting conditions) of live teleophthalmology consultations in NHS Forth Valley before and during the COVID-19 national lockdown.
Methods
An NHS secure video conferencing platform connected the video slit lamps of optometrists, or an iPad mounted on a slit lamp and viewing through the eyepieces, to a secondary care ophthalmologist via a virtual live clinic/waiting area. Data about avoiding a secondary care referral were extracted from a post-consultation ophthalmologist survey for 14 months of data. Pre- and during-lockdown intervals were before/after 23 March 2020, when routine eyecare appointments were suspended. Numbers of avoided referrals to secondary care and patterns of presenting conditions were compared for pre- and during-lockdown periods.
Results
The COVID-19 pandemic markedly increased use of live teleophthalmology in NHS Forth Valley. Surveys were completed for 164 of 250 (66%) teleophthalmology consultations over the study period. Data from 154 surveys were analysed, 78 and 76 for the pre- and during-lockdown periods, respectively. Significantly more during-lockdown (86%) than pre-lockdown (64%; difference 21%, 95% CI 8–34%, p = 0.001) surveys indicated that referrals to secondary care were avoided.
Conclusion
Survey data from ophthalmologists suggest significantly fewer escalations to secondary care due to teleophthalmology use.
Acknowledgements
The initial pilot was described as part of an MSc in Primary Care Ophthalmology, University of Edinburgh. We would also like to acknowledge Eric Hill, NHS Forth Valley, IT support; John Keenan, Specsavers Alloa; Kirsty Jordan, University of Strathclyde, for the design of the iPad slit lamp adaptors; Linda Hunter, LA Optical and Sebastien Dall’Ozzo, NHS Forth Valley.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Compliance with ethical standards
Following consultation with local NHS Research and Development, this work was classified as an audit of a service development and no ethics approval was required. This work was done in accordance with the Declaration of Helsinki 1975.