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Expansion of patient eligibility for virtual glaucoma clinics: a long-term strategy to increase the capacity of high-quality glaucoma care
  1. Eleni Nikita1,
  2. Gus Gazzard1,2,3,
  3. Dawn A Sim3,4,
  4. Sandro Fasolo5,
  5. Karsten Kortum4,
  6. Hari Jayaram1,2,3
  1. 1Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2Institute of Ophthalmology, University College London, London, UK
  3. 3NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  4. 4Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  5. 5Performance & Information, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Eleni Nikita, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK; eleni.nikita{at}nhs.net

Abstract

Aims The virtual glaucoma clinic (VGC) is a well-established diagnostic pathway for delivery of glaucoma care. Current UK national guidance recommends VGCs for patients with ocular hypertension, glaucoma suspects or early glaucoma. This study evaluates whether expanded eligibility criteria, including other glaucoma phenotypes and disease stages, can deliver safe and effective care with a positive patient experience.

Methods Records of over 8000 patients were reviewed in order to determine suitability for VGC attendance using expanded eligibility criteria. Patients with three prior consecutive visits within the glaucoma service were included. Follow-up interval, clinic type, visual acuity (VA), intraocular pressure (IOP) and visual field performance were recorded. Patient satisfaction was recorded for a sample of 118 patients.

Results 2017 patients over 31 months were included. Two-thirds of eyes had ocular comorbidities, a fifth of eyes had undergone prior cataract surgery and 10% of eyes had undergone a prior laser treatment for glaucoma. After three visits, 32% of patients remained in the VGC, 42% were seen in face-to-face clinics and 25% were discharged. There were no clinically significant changes in VA, IOP and visual field performance during follow-up. 72% of patients expressed a preference to continue their care within VGCs.

Conclusions This study demonstrates that VGCs with expanded patient eligibility criteria can deliver high-quality glaucoma care that is safe, effective and with high levels of patient satisfaction. This approach provides a long-term solution to adapt delivery of glaucoma care to our expanding and ageing population.

  • glaucoma
  • telemedicine

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All participant data used were deidentified.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All participant data used were deidentified.

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Footnotes

  • Twitter @gusgazzard, @dawnasim

  • Contributors EN, SF and KK carried out the data collection and analysis; EN, HJ and GG contributed to the first draft; and all authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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