Live teleophthalmology avoids escalation of referrals to secondary care during COVID-19 lockdown

Abstract

Clinical relevance Following COVID-19 lockdown, uptake of slit lamp 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 realtime, three-way consultation between secondary care, community providers and patients, improving interpretation of slit lamp finding 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 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 COVID-19 national lockdown. Methods An NHS secure video conferencing platform connected optometrists’ video slit lamp, 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 March 23rd 2020, when routine eyecare appointments were suspended. Numbers of avoided referrals to secondary care and patterns of presenting condition were compared for pre- and during-lockdown periods. Results 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%; 95% CI of difference 8–34%, p=0.001) surveys indicated that referrals to secondary care were avoided. Conclusion The COVID-19 pandemic markedly increased use of live teleophthalmology in NHS Forth Valley. Survey data from ophthalmologists suggest significantly fewer escalations to secondary care due to teleophthalmology use.

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Identifiers

DOI

https://doi.org/10.1080/08164622.2021.1916383

Repository URI

https://strathprints.strath.ac.uk/76215/