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

The value of virtual glaucoma clinics: a review

Virtual clinics are being utilised to tackle the growing demand for glaucoma healthcare. We conducted a literature search on 28 February 2023 using MEDLINE (PubMed), EMBASE and Web of Science databases. We searched for studies on virtual glaucoma clinics, published in the English language between 2000 and 2023. Studies suggest that virtual glaucoma clinics are a safe and effective alternative to traditional face-to-face clinics for patients with stable and early-to-moderate glaucoma. Patient satisfaction is high across all clinics surveyed. Satisfaction appears to be linked to good communication, trust and improved waiting times. The majority of healthcare professionals are also content with virtual glaucoma clinics. There are no dedicated cost-benefit analyses for virtual glaucoma clinics in the UK. However, virtual clinics in other specialties have reported significant cost savings.

[Sustainability in ophthalmology : Adaptation to the climate crisis and mitigation]

Die Klimakrise bedroht die Gesundheit heutiger und künftiger Generationen und stellt das Gesundheitssystem vor besondere Herausforderungen. Zur Anpassung an den anthropogene Klimawandel sind umfängliche Adaptationsstrategien und eine Mitigation des Klimawandels notwendig. In der Medizin sowie in der Augenheilkunde gibt es vielfältige Möglichkeiten zur Reduktion des CO₂(Kohlendioxid)-Fußabdrucks, die es zu ergreifen gilt, die ordnungspolitisch gefördert und eingefordert werden sollten. Das aufkommende Feld der datengesteuerten Nachhaltigkeit kann Werkzeuge liefern, um den ökologischen Fußabdruck der eigenen Tätigkeit zu evaluieren sowie Optimierungen zu initiieren. Lebenszyklusanalysen können Instrumente für systematische Ökobilanzen sein und nachhaltige Produkt- und Praxisentscheidungen ermöglichen. Das deutsche Gesundheitssystem sollte eine quantifizierbare und holistische Strategie zur CO₂-Reduktion entwickeln; Nachhaltigkeit könnte zukünftig ein Leistungsindikator sein. Dieser Artikel diskutiert mit augenärztlicher Perspektive Beispiele zur Adaptation an die Klimakrise und zur Mitigation; dies schließt kleine Maßnahmen, die jeder Einzelne umsetzen kann, als auch größere, strukturelle Ansätze ein.

How glaucoma care changed for the better after the pandemic

PURPOSE OF REVIEW

The current article reviews enhancements to the delivery of glaucoma care that developed in response to the coronavirus disease 19 (COVID-19) pandemic and are likely to persist beyond its resolution.

RECENT FINDINGS

Literature from the review period (2020-2021) includes reports highlighting contributions of the ophthalmology community to global health during the pandemic. Glaucoma practices worldwide have instituted more robust infection control measures to mitigate severe acute respiratory syndrome coronavirus 2 transmission in the outpatient setting, and many of these modifications will endure in the post-COVID era. Operational adjustments have led to the provision of more efficient glaucoma care. A hybrid care model involving technician-based diagnostic testing and subsequent virtual consultation with a glaucoma specialist has evolved as a useful adjunct to traditional face-to-face encounters with patients.

SUMMARY

Glaucoma specialists, patients, and staff have adapted to a 'new normal' of glaucoma care delivery during the COVID-19 pandemic. Although innovation has propelled several improvements to glaucoma care during this global health crisis, significant barriers to more widespread implementation of teleglaucoma still exist. Whether, and in what capacity, the pandemic has permanently altered glaucoma practice patterns remains to be seen.

Orthoptic service survey in the UK and Ireland during the interim recovery period (summer 2020) of the COVID-19 pandemic

COVID-19 extended through 2020 with impact on all hospital services. The purpose of this study was to determine the extent of orthoptic service provision during the initial recovery period from July to September 2020 in the UK, Ireland and Channel Islands. We conducted a prospective survey-based cross-sectional study using an online survey aiming for coverage of orthoptic departments across the UK, Ireland and Channel Islands. The survey sought to gather data on orthoptic practice during the COVID-19 pandemic period between the first and second waves in the UK. Questions included within the survey asked about the impact on services paused or reduced during the pandemic, the reinstatement of services, backlog of appointments, changes to arrangement and conduct of appointments, changes to working practice, impact to lives of orthoptists, and access by orthoptists to professional support and guidelines. We circulated the online survey through the British and Irish Orthoptic Society that reaches over 95% of UK and Irish orthoptic services and through social media and orthoptic research networks. This survey was open from July 1^st to September 30^th 2020 and achieved a response rate from orthoptic departments of 85%. A high rate (92%) of teleconsultations continued with 50% of departments using a proforma to guide the teleconsultation and with added use of risk assessment for patient appointments. To enable reopening of clinics, multiple changes were made for patient and staff flow through clinic areas. Reduced clinical capacity was confirmed by 76.5% of departments. Appointments averaged 15-20 minutes and there was routine use of PPE and cleaning and adoption of staggered appointments with added evening/weekend clinics. There was increased use of information resources/leaflets for patients and dependence on professional and health care guidance documents. The average backlog for patient appointments had increased to 26 weeks. The initial UK and Irish recovery phase in summer 2020 allowed a glimpse at adjustments needed to reopen orthoptic clinics for in-person appointments. Teleconsultation remained in frequent use but with greater risk assessment and triage to identify those requiring in-person appointments.