How Beneficial is Remote DR Care?

New telemedicine technologies could improve monitoring and care. Howard Larkin reports

Growth in telemedicine technology use spurred by the COVID-19 pandemic could revolutionise diabetic eye care. Remote monitoring made possible by home-OCT and wide-field fundus cameras could do a better job of detecting and diagnosing diabetic retinopathy (DR) and diabetic macular oedema (DME) earlier, allowing treatment before vision is permanently lost, said Tunde Peto MD, PhD at the Association for Research in Vision and Ophthalmology 2021 Annual Meeting.

DR and DME are particularly pernicious because, by the time they appear, symptoms are advanced to the point where vision loss is often irreversible, noted Dr Peto, Queen’s University Belfast, Northern Ireland, UK. This makes regular monitoring of diabetic patients essential. Other ocular issues common in diabetic patients include dry eye, anterior segment disease, and cataracts, she noted.

Yet even before the pandemic, “good quality diabetic eye care was not universally available,” Dr Peto said. According to a DR Barometer study conducted in 41 countries, nearly half of providers reported they did not use written protocols for managing diabetes-related vision loss, 21% of ophthalmologists said they had not trained in DR or DME diagnosis and treatment, and 27% of patients never discussed eye problems with their doctors until they already had symptoms.

The pandemic likely made this situation worse by cancelling non-urgent examinations and diverting ophthalmic personnel to COVID clinics. On the plus side, the pandemic encouraged development of remote monitoring, drivethrough clinics, effective triage of who needs to be seen in person, and protocols to limit infection exposure risk in office visits. These developments are likely permanent changes and could improve diabetic eye care, Dr Peto said.

REDESIGNING PATIENT FLOW However, minimising contact while maintaining care quality requires reinventing patient flow and the role of every care team member, Dr Peto said. Questions include what resources are now in place and whether current team members can perform virtual interviews and triage and collect images remotely.

“Do we need more technicians; do we need more nursing assistants? How do we get buy-in from everyone … and what would be the ideal solution look like now and in a year’s time?” Dr Peto asked.

Virtual clinics are excellent, but they take time to run and read the images appropriately, Dr Peto said. In designing them, consider both the patient benefit and medico-legal issues, as the images produced are available for all to see. Also, make sure the team is up to the task and trained well to provide the best care to patients. Then run a “holiday test.” If the system doesn’t work when the primary physician is absent, it needs strengthening, she said. SLO/OCT model ・ SLO model

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