Digital Ophthalmology in the UK – Diabetic Retinopathy Screening and Virtual Glaucoma Clinics in the National Health Service

Abstract

The customary doctor and patient interactions are currently undergoing significant changes through technological advances in imaging and data processing and the need for reducing person-to person contacts during the COVID-19 crisis. There is a trend away from face-to-face examinations to virtual assessments and decision making. Ophthalmology is particularly amenable to such changes, as a high proportion of clinical decisions are based on routine tests and imaging results, which can be assessed remotely. The uptake of digital ophthalmology varies significantly between countries. Due to financial constraints within the National Health Service, specialized ophthalmology units in the UK have been early adopters of digital technology. For more than a decade, patients have been managed remotely in the diabetic retinopathy screening service and virtual glaucoma clinics. We describe the day-to-day running of such services and the doctor and patient experiences with digital ophthalmology in daily practice.

Key words

diabetic retinopathy - screening - glaucoma

Publication History

Received: 04 October 2020

Accepted: 29 October 2020

Article published online:
07 December 2020

• References/Literatur

• 1 Keesara S, Jonas A, Schulman K. Covid-19 and Health Careʼs Digital Revolution. N Engl J Med 2020; 382: e82 doi:10.1056/NEJMp2005835
• 2 Li JO, Liu H, Ting DSJ. et al. Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective. Prog Retin Eye Res 2020; DOI: 10.1016/j.preteyeres.2020.100900.
• 3 Wood EH, Korot E, Storey PP. et al. The retina revolution: signaling pathway therapies, genetic therapies, mitochondrial therapies, artificial intelligence. Curr Opin Ophthalmol 2020; 31: 207-214 doi:10.1097/icu.0000000000000656
• 4 Wendt C. [International comparison of health care systems. Overview of state of research]. Gesundheitswesen 2006; 68: 593-599 doi:10.1055/s-2006-927046
• 5 Holz FG, Tadayoni R, Beatty S. et al. Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration. Br J Ophthalmol 2015; 99: 220-226 doi:10.1136/bjophthalmol-2014-305327
• 6 Flaxman SR, Bourne RRA, Resnikoff S. et al. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. Lancet Glob Health 2017; 5: e1221-e1234 doi:10.1016/s2214-109x(17)30393-5
• 7 [Anonymous] Diabetes care and research in Europe: the Saint Vincent declaration. Diabet Med 1990; 7: 360
• 8 Olafsdottir E, Andersson DK, Stefánsson E. Visual acuity in a population with regular screening for type 2 diabetes mellitus and eye disease. Acta Ophthalmol Scand 2007; 85: 40-45 doi:10.1111/j.1600-0420.2006.00753.x
• 9 Dobrow MJ, Hagens V, Chafe R. et al. Consolidated principles for screening based on a systematic review and consensus process. CMAJ 2018; 190: E422-E429 doi:10.1503/cmaj.171154
• 10 Jones S, Edwards RT. Diabetic retinopathy screening: a systematic review of the economic evidence. Diabet Med 2010; 27: 249-256 doi:10.1111/j.1464-5491.2009.02870.x
• 11 James M, Turner DA, Broadbent DM. et al. Cost effectiveness analysis of screening for sight threatening diabetic eye disease. BMJ 2000; 320: 1627-1631 doi:10.1136/bmj.320.7250.1627
• 12 Scanlon PH. The English National Screening Programme for diabetic retinopathy 2003–2016. Acta Diabetol 2017; 54: 515-525 doi:10.1007/s00592-017-0974-1
• 13 Forbes LJ, Marchand C, Doran T. et al. The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review. Br J Gen Pract 2017; 67: e775-e784 doi:10.3399/bjgp17X693077
• 14 Pandit RJ, Taylor R. Quality assurance in screening for sight-threatening diabetic retinopathy. Diabet Med 2002; 19: 285-291 doi:10.1046/j.1464-5491.2002.00722.x
• 15 Mathur R, Bhaskaran K, Edwards E. et al. Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the Clinical Practice Research Datalink 2004–2014. BMJ Open 2017; 7: e014444 doi:10.1136/bmjopen-2016-014444
• 16 Kreft D, McGuinness MB, Doblhammer G. et al. Diabetic retinopathy screening in incident diabetes mellitus type 2 in Germany between 2004 and 2013 – A prospective cohort study based on health claims data. PLoS One 2018; 13: e0195426 doi:10.1371/journal.pone.0195426
• 17 Kristinsson JK, Hauksdóttir H, Stefánsson E. et al. Active prevention in diabetic eye disease. A 4-year follow-up. Acta Ophthalmol Scand 1997; 75: 249-254 doi:10.1111/j.1600-0420.1997.tb00766.x
• 18 Liew G, Michaelides M, Bunce C. A comparison of the causes of blindness certifications in England and Wales in working age adults (16–64 years), 1999–2000 with 2009–2010. BMJ Open 2014; 4: e004015 doi:10.1136/bmjopen-2013-004015
• 19 Thomas RL, Luzio SD, North RV. et al. Retrospective analysis of newly recorded certifications of visual impairment due to diabetic retinopathy in Wales during 2007–2015. BMJ Open 2017; 7: e015024 doi:10.1136/bmjopen-2016-015024
• 20 Scanlon PH, Malhotra R, Greenwood RH. et al. Comparison of two reference standards in validating two field mydriatic digital photography as a method of screening for diabetic retinopathy. Br J Ophthalmol 2003; 87: 1258-1263 doi:10.1136/bjo.87.10.1258
• 21 Peto T, Tadros C. Screening for diabetic retinopathy and diabetic macular edema in the United Kingdom. Curr Diab Rep 2012; 12: 338-345 doi:10.1007/s11892-012-0285-4
• 22 Oke JL, Stratton IM, Aldington SJ. et al. The use of statistical methodology to determine the accuracy of grading within a diabetic retinopathy screening programme. Diabet Med 2016; 33: 896-903 doi:10.1111/dme.13053
• 23 Amoaku WM, Ghanchi F, Bailey C. et al. Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group. Eye (Lond) 2020; 34: 1-51 doi:10.1038/s41433-020-0961-6
• 24 Lagan MA, OʼGallagher MK, Johnston SE. et al. Angle closure glaucoma in the Northern Ireland Diabetic Retinopathy Screening Programme. Eye (Lond) 2016; 30: 1091-1093 doi:10.1038/eye.2016.98
• 25 Ong HS, Levin S, Vafidis G. Glaucoma detection using optic disc images from the English national screening programme for diabetic retinopathy. J Glaucoma 2013; 22: 496-500 doi:10.1097/IJG.0b013e3182447d58
• 26 Hussain R, Czanner G, Taktak A. et al. Mortality of patients with uveal melanoma detected by diabetic retinopathy screening. Retina 2020; 40: 2198-2206 doi:10.1097/iae.0000000000002763
• 27 Leese GP, Boyle P, Feng Z. et al. Screening uptake in a well-established diabetic retinopathy screening program: the role of geographical access and deprivation. Diabetes Care 2008; 31: 2131-2135 doi:10.2337/dc08-1098
• 28 Gulliford MC, Dodhia H, Chamley M. et al. Socio-economic and ethnic inequalities in diabetes retinal screening. Diabet Med 2010; 27: 282-288 doi:10.1111/j.1464-5491.2010.02946.x
• 29 Forster AS, Forbes A, Dodhia H. et al. Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study. Diabetologia 2013; 56: 2187-2193 doi:10.1007/s00125-013-2975-0
• 30 Fenner BJ, Wong RLM, Lam WC. et al. Advances in Retinal Imaging and Applications in Diabetic Retinopathy Screening: A Review. Ophthalmol Ther 2018; 7: 333-346 doi:10.1007/s40123-018-0153-7
• 31 Xie Y, Gunasekeran DV, Balaskas K. et al. Health Economic and Safety Considerations for Artificial Intelligence Applications in Diabetic Retinopathy Screening. Transl Vis Sci Technol 2020; 9: 22 doi:10.1167/tvst.9.2.22
• 32 Olvera-Barrios A, Heeren TF, Balaskas K. et al. Diagnostic accuracy of diabetic retinopathy grading by an artificial intelligence-enabled algorithm compared with a human standard for wide-field true-colour confocal scanning and standard digital retinal images. Br J Ophthalmol 2020; DOI: 10.1136/bjophthalmol-2019-315394.
• 33 Olafsdóttir E, Stefánsson E. Biennial eye screening in patients with diabetes without retinopathy: 10-year experience. Br J Ophthalmol 2007; 91: 1599-1601 doi:10.1136/bjo.2007.123810
• 34 Agardh E, Tababat-Khani P. Adopting 3-year screening intervals for sight-threatening retinal vascular lesions in type 2 diabetic subjects without retinopathy. Diabetes Care 2011; 34: 1318-1319 doi:10.2337/dc10-2308
• 35 Younis N, Broadbent DM, Vora JP. et al. Incidence of sight-threatening retinopathy in patients with type 2 diabetes in the Liverpool Diabetic Eye Study: a cohort study. Lancet 2003; 361: 195-200 doi:10.1016/s0140-6736(03)12267-2
• 36 Gunn PJG, Marks JR, Au L. et al. Acceptability and use of glaucoma virtual clinics in the UK: a national survey of clinical leads. BMJ Open Ophthalmol 2018; 3: e000127 doi:10.1136/bmjophth-2017-000127
• 37 Harper RA, Gunn PJG, Spry PGD. et al. Care pathways for glaucoma detection and monitoring in the UK. Eye (Lond) 2020; 34: 89-102 doi:10.1038/s41433-019-0667-9
• 38 Tuck MW, Crick RP. The age distribution of primary open angle glaucoma. Ophthalmic Epidemiol 1998; 5: 173-183 doi:10.1076/opep.5.4.173.4192
• 39 Tuck MW, Crick RP. The projected increase in glaucoma due to an ageing population. Ophthalmic Physiol Opt 2003; 23: 175-179 doi:10.1046/j.1475-1313.2003.00104.x
• 40 Desai P, Minassian DC, Reidy A. et al. Number of incident cases of the main eye diseases of ageing in the UK Biobank cohort, projected over a 25-year period from time of recruitment. Br J Ophthalmol 2018; 102: 1533-1537 doi:10.1136/bjophthalmol-2017-311289
• 41 Kotecha A, Longstaff S, Azuara-Blanco A. et al. Developing standards for the development of glaucoma virtual clinics using a modified Delphi approach. Br J Ophthalmol 2018; 102: 531-534 doi:10.1136/bjophthalmol-2017-310504
• 42 Clarke J, Puertas R, Kotecha A. et al. Virtual clinics in glaucoma care: face-to-face versus remote decision-making. Br J Ophthalmol 2017; 101: 892-895 doi:10.1136/bjophthalmol-2016-308993
• 43 Spackman W, Waqar S, Booth A. Patient satisfaction with the virtual glaucoma clinic. Eye (Lond) 2020; DOI: 10.1038/s41433-020-0946-5.
• 44 Court JH, Austin MW. Virtual glaucoma clinics: patient acceptance and quality of patient education compared to standard clinics. Clin Ophthalmol 2015; 9: 745-749 doi:10.2147/opth.S75000
• 45 Kotecha A, Bonstein K, Cable R. et al. Qualitative investigation of patientsʼ experience of a glaucoma virtual clinic in a specialist ophthalmic hospital in London, UK. BMJ Open 2015; 5: e009463 doi:10.1136/bmjopen-2015-009463