The post-COVID19 “Office”
Teleglaucoma
At the beginning Prof. Karim Damji spoke about the benefits, the set-up involved and the different models of care for teleglaucoma. He shared his experiences and learnings of the collaborative care teleglaucoma model that is adopted in Edmonton, Canada and piloted in Ethiopia and Kenya.
Prof Damji also addressed the challenges of teleglaucoma, and highlighted some of the important aspects that need to be improved particularly in the post pandemic context.
Remote VF testing
Dr. George Kong talked about the benefits and challenges of home monitoring of visual fields and provided an update of the technologies and devices that are currently available for visual field testing at home. He then discussed the performance of the Melbourne Rapid Test (MRT) in the clinic setting, as well as its uptake and performance as a home-based monitoring device.
Remote tonometry
Dr. Thomas Johnson described the various technologies and devices that are capable of measuring the intraocular pressure outside the office setting, more specifically on the Icare Home, which is designed for self-administration and measurement of IOP.
He elaborated on its reliability, accuracy, and patient acceptance; and also discussed important clinical scenarios where ‘out of office’ IOP measurements are indicated.
Disseminated Care Models
In this talk, Dr. Srinivasan Kavitha described the three innovative models of care at Aravind Eye Hospitals that were adapted to optimize patient care during the unique Covid19 pandemic situation. She first described the changes that were instituted in the clinics within the hospital setting, and then described two new disseminated models of care that integrated remote collection of clinical information and investigations, coupled with telemedicine consult.
In one model, eye examination and investigations were performed at designated ‘Vision Centres’ whereas in the other model that is aptly described as the ‘Uberization of eyecare’, the procedures were performed at the patients’ home by a trained technician, which was then followed by telemedicine consultation with an ophthalmologist at a tertiary hospital.
Risk stratification/ How often do patients need to be seen
Prof. David Crabb spoke about the importance of risk stratification in glaucoma to not only save vision but also costs to the healthcare system. Providing evidence from ‘Big’ data analyses, he showed that there is a high variability in progression rates and risks for progression to blindness, yet there are minimal differences in the frequency of disease monitoring.
Dr Crabb suggests that resources should be directed to those with the greatest risk of losing vision in their lifetime.
