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NEW YORK (Reuters Health) – A teleglaucoma program targeted at U.S. veterans showed high reliability and high patient satisfaction in a new pilot study.

“The study was conducted at the VA of Pittsburgh, which covers a large geographic area, where I am the only glaucoma specialist, buy online actos coupons without prescription ” Dr. Julia Polat of the University of Pittsburgh Medical Center told Reuters Health by email. “Veterans were frequently traveling for several hours each way to see me, sometimes spending an entire day on a single visit.”

In the U.S., she added, “There were no telemedicine glaucoma treatment protocols or studies, only screening programs. The lack of an established protocol prompted this pilot study.”

As reported in Ophthalmology Glaucoma, the pilot safety study included 40 eyes of 20 patients referred for glaucoma subspecialist opinion. Participants’ median age was 70 and all but two were men. Safety was assessed by determining inter-observer and intra-observer consistency – i.e., comparing an in-person assessment by a glaucoma subspecialist with the remote assessment of two other glaucoma subspecialists.

In the pilot study, inter-observer and intra-observer consistency showed a high level of agreement, with a Krippendorff’s alpha of 0.86 and 0.92, respectively, for diagnosis, and 0.86 and 0.85 for treatment plan.

A secondary study of the efficacy and acceptability of the program included 118 patients; the median age was 71 and most were men. In that study, patient satisfaction scores on a survey were 4.55 out of 5, with 5 being maximal satisfaction.

Further, consult lead time improved considerably, with a median time of three days for a doctor to respond to an electronic consult versus a median of 43 days for an in-person visit.

Teleglaucoma also benefited the health system by reducing the time doctors spent reviewing each case – i.e., history, exam findings, imaging results, 23 visual fields – to 19 minutes for a teleglaucoma consult versus 31 minutes for an in-person evaluation.

Dr. Polat said, “This program can be adapted and applied at other institutions. It requires remote sites that are able to acquire the necessary imaging and data from the patients in person, a method to electronically transmit the data, and a glaucoma-trained physician who is able to interpret the gathered data/imaging and provide a diagnosis and treatment plan.”

“Unless a patient was referred, unfortunately, we had no way of identifying patients who would benefit from our services,” she added. “Therefore, when starting such programs, it is very important to educate referring sites about the type of patient who should be referred to ensure that they are being appropriately screened and, therefore, have the opportunity for early intervention/treatment.”

Dr. Christopher Starr, Director of Ophthalmic Education and of the Fellowship Program in Cornea, Cataract and Laser Vision Correction Surgery at Weill Cornell Medicine and NewYork-Presbyterian in New York City, commented in an email to Reuters Health. “This is a helpful adjunct to the typical in-person face-to-face examination. As described in the study, the quality of the glaucoma assessment is quite high and on par with a traditional visit but saves significant time, resources and cost.”

“While I don’t see this model overtaking a traditional periodic in-person visit with a glaucoma specialist, it can be very useful for follow-up visits – i.e., perhaps a reasonable (approach) would be one or two in-person visits per year with three or four supplemental tele-visits per year remotely,” he suggested. “This would reduce the significant time and cost expenditures on both doctors and patients while maintaining the same high level of care and medical decision making.”

“In fact,” he noted, “since the telemedicine visits are much easier, we might be able to monitor some higher-risk patients more closely via this model with fewer treatment delays and reduced progression rates.”

“I’d like to see longer-term outcomes, since glaucoma typically progresses at a slow pace,” he added. “Data on visual field progression and optic nerve metrics of telemedicine-managed patients versus traditional patients would be interesting.”

SOURCE: Ophthalmology Glaucoma, online April 9, 2021.

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