Accuracy of periocular lesion assessment using telemedicine

Is an image-based eyelid management service safe and effective?

INTRODUCTION

The COVID-19 pandemic created a requirement for reduced patient contact and reduced capacity in clinics. We previously published results of an Image-Based Eyelid Lesion Management Service (IBELMS) which was found non-inferior to traditional face-to-face clinic at diagnosing lesions and identifying eyelid malignancies. We now present first-year safety and efficacy data from this service.

METHODS

Data were collected retrospectively on all patients seen in NHS Greater Glasgow and Clyde eyelid photography clinics from 30th September 2020 to 29th September 2021, including referral source and diagnosis, time to clinic review, treatment and patient outcomes.

RESULTS

808 patients were included in the study. Chalazion was the most common diagnoses recorded (38.4%). There was a statistically significant decrease in mean time from referral to appointment time between the first 4 months and last 4 months of the service (93 days to 22 days, p ≤ 0.0001). 266 (33%) of patients were discharged following photographs, 45 (6%) were discharged for non-attendance and 371 (46%) were booked for a minor procedure. 13 biopsy-confirmed malignant lesions were identified; only 3 had been referred as suspected malignancy. 23 patients out of 330 with at least 6 months follow up (7%) were re-referred within 6 months of treatment or discharge; however, none of them with a missed periocular malignancy.

DISCUSSION

Eyelid photography clinics effectively reduce patient waiting times and maximise clinic capacity. They accurately identify eyelid lesions including malignancies with a low re-referral rate. We propose that an image-based service for eyelid lesions is a safe and effective way of managing such patients.

Accuracy of trained technicians in screening orbital and adnexal diseases at rural vision centers in South India

Purpose

To assess the agreement between the diagnosis made by trained technicians at vision centers (VC) and oculoplasty specialists at the base hospital, in patients referred from VC to the orbit and oculoplasty clinic of a tertiary eye care hospital in south India.

Methods

This was a retrospective study that compared the findings of VC technicians and the specialists of the orbit and oculoplasty services in a base hospital. A total of 384 patients referred from 17 VCs between May 2021 and May 2022 were included. The diseases were categorized according to the site of involvement as diseases of the eyelids (43%), diseases of the lacrimal system (37.3%), orbital diseases (15.6), and others (4.1%). The mean age of the patients was 35.9 years and 50.6% were females. Medical records of all referred patients who attended the orbit clinic were analyzed.

Results

Of the 384 patients, 378 (98.67%) were confirmed to have o.

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bital and adnexal diseases. There was an overall 80% agreement between the diagnosis made by trained VC technicians and oculoplasty specialists; the kappa coefficient was 0.78 (95% confidence interval [CI]: 0.76 to 0.80), with a P value < 0.001. The agreement was the highest for diseases of the lacrimal system (90.9%, kappa coefficient 0.87), followed by eyelid pathologies (80%, kappa coefficient: 0.77). Of these, 54.8% of patients were managed with surgical procedures.

Conclusion

There is good agreement between the findings of VC technicians and oculoplasty specialists. Trained technicians can help in the early detection and referral to higher centers. They also help to make sure adherence to treatment and periodic evaluation, especially in resource-constraint settings.

Introducing the 'Benign Eyelid Lesion Pathway': 1 year experience of synchronous tele-oculoplastics in a tertiary hospital

BACKGROUND

Patients with benign eyelid lesions make up a large proportion of referrals to the oculoplastic service and lend themselves well to telemedicine with assessments heavily reliant on history, observation-based examination and photographs to enable management decision-making. Our tertiary unit set up tele-oculoplastics clinics for all new patients referred for benign eyelid lesions comprising tele-consultation with antecedent patient photograph: Benign Eyelid Lesion Pathway (BELP). One year on, we describe a retrospective analysis of 974 patients looking at distinct parameters of effectiveness.

METHODS

We retrospectively collected data from electronic patient records (EPR) for BELP patients from July 2020 to August 2021 (n = 974). We analysed time efficiency (referral time to treatment plan, consultation duration in minutes, average waiting times, number of patients seen per clinician and DNA rate), accessibility, safety (via video surveillance clinic) and theatre utilisation.

RESULTS

57.3% (n = 558) were listed for a surgical procedure direct from tele-consultation with 94.9% (n = 513) of these proceeding to surgery; 22.8% (n = 222) were discharged, 10.7% (n = 104) had further video follow-up and 6.7% (n = 65) required face-to-face follow-up. Our results showed efficient referral-to-treatment times, waiting times, consultation times and non-attendance rate. There was only a 2.57% non-attendance rate. There was no missed diagnosis of a malignancy of a presumed benign lesion.

CONCLUSION

Tele-oculoplastics provides a streamlined, safe, effective, and logistically convenient way to review benign eyelid lesions. With the increased waiting times for referral to biopsy of eyelid lesions, this clinic shows it is imperative to provide digital accessibility for patient assessment and booking to operating theatre.

Knowledge, Attitudes, and Perceptions of Jordanians Toward Adopting and Using Telemedicine: National Cross-sectional Study

Background

Due to the upsurge of COVID-19, nations are increasingly adopting telemedicine programs in anticipation of similar crises. Similar to all nations worldwide, Jordan is implementing efforts to adopt such technologies, yet it is far from complete.

Objective

This study aims to assess the knowledge, attitudes, and perceptions of Jordanians toward telemedicine, to identify key factors predisposing individuals to its use or acting as barriers to its implementation.

Methods

We implemented a cross-sectional design using an online, self-administered questionnaire executed in Google Forms and distributed through social media. Differences in knowledge and attitude scores were examined using independent sample t tests and ANOVA. A multivariate linear regression model was computed to assess predictors of awareness toward telemedicine.

Results

A total of 1201 participants fully completed the questionnaire. Participants were characterized by a mean age of 36.3 (SD 14.4) years and a male-to-female ratio of nearly 1:1. About 50% (619/1201, 51.5%) of our studied population were aware of telemedicine, while nearly 25% (299/1201, 24.9%) declared they had observed it in action. Approximatively 68% (814/1201, 67.8%) of respondents were willing to use telemedicine. The majority of the sample portrayed favorable and positive views toward telemedicine. Higher educational degrees, living in urban districts, and having a higher perception of electronic usage ability were associated with higher knowledge and better attitudes toward telemedicine (all P<.05). The multivariate linear regression analysis demonstrated that perceived ability to use electronics was associated with positive attitudes (β=0.394; 95% CI 0.224 to 0.563), while living in Southern Jordan predicted poor attitudes toward telemedicine (β=–2.896; 95% CI –4.873 to –0.919).

Conclusions

Jordanians portray favorable perceptions of telemedicine. Nonetheless, concerns with regards to privacy, medical errors, and capacity for accurate diagnoses are prevalent. Furthermore, Jordanians believe that integrating telemedicine within the health care system is not applicable due to limited resources.

Descriptive study of a telemedicine program in palpebral pathology for primary care (tele-eyelid)

BACKGROUND AND OBJECTIVE

In 2013 we implemented an asynchronous telemedicine circuit for the diagnosis of eyelid diseases (tele-eyelid), connecting the outpatient primary healthcare with the hospital's specialists. The purpose of this study is to assess the use of telemedicine in the diagnosis of eyelid diseases by primary care teams, to evaluate its usefulness and to analyse the epidemiology of the pathological conditions referred to the tertiary level hospital, as well as the need for surgery.

MATERIALS AND METHODS

This study was carried out in the Spanish public health system, in a mainly rural area assisted by the Institut Català de la Salut (ICS) and Althaia Xarxa Assistencial Universitària de Manresa. This is a retrospective, descriptive analysis of the telematic consultations undertaken between 2013 and 2019. The consultations between 2018 and 2019 underwent a further descriptive retrospective-prospective analysis to assess the conditions referred to the hospital.

RESULTS

Unnecessary referrals were avoided in 72% of telematic consultations. More than 50% of primary care practitioners used tele-eyelid. Up to 68% of the referrals were due to eyelid tumours, 50% needed surgery and 18%, a biopsy. Moreover, we found a high reliability between telematic and face-to-face diagnosis.

CONCLUSIONS

Teleophthalmology applied to eyelid pathology is a useful tool to improve access to specialized care and helps solving pathological conditions. It avoids unnecessary consultations and increases efficiency, both in primary and hospital care.

Clinical outcomes and operational impact of a medical photography based teledermatology service with over 8,000 patients in the UK

A new, store-and-forward, fully digitised Teledermatology (TD) pathway was designed and implemented in an urban setting for non-two-week wait routine patients. In total 8,352 new patients had a TD consultation over 37 months. Of these, 4,748 (56.8%) were referred back to their GP, 1,634 (19.6%) were referred directly for a surgical procedure and 1,970 (23.6%) for a face-to-face review with a Dermatologist (F2F). The average waiting time for a TD appointment was 3 vs. 30 weeks for a routine F2F appointment. Between 2019 and 2018, TD referrals rose by 38%, routine dermatology referrals reduced by 16% and cancer referrals increased by 6%. Using medical photographers proved to be effective with only two cases (0.02%) of images being of insufficient quality to form a clinical opinion. Hitherto, savings for the local Commissioning Groups were estimated at £671,218. Last financial year savings (2019-2020) were £284,671. The average cost savings per TD patient appointment was £80.36. Savings in the Trust's overhead costs were £53,587. TD consultants reviewed almost twice the number of patients vs. F2F for the same amount of consultant programmed activities. 95% of surveyed patients would be likely or extremely likely to recommend this service to friends and family.

Digital Transformation in Ophthalmic Clinical Care During the COVID-19 Pandemic

ABSTRACT

COVID-19 has placed unprecedented pressure on health systems globally, whereas simultaneously stimulating unprecedented levels of transformation. Here, we review digital adoption that has taken place during the pandemic to drive improvements in ophthalmic clinical care, with a specific focus on out-of-hospital triage and services, clinical assessment, patient management, and use of electronic health records. We show that although there have been some successes, shortcomings in technology infrastructure prepandemic became only more apparent and consequential as COVID-19 progressed. Through our review, we emphasize the need for clinicians to better grasp and harness key technology trends such as telecommunications and artificial intelligence, so that they can effectively and safely shape clinical practice using these tools going forward.