Abstract

Purpose: To identify the value of asynchronous virtual glaucoma clinics in the detection of ocular morbidity from glaucoma in a remote and rural population in the UK.
Methods: On Orkney clinics were set up using the Royal College of Ophthalmologists guidelines for virtual glaucoma clinics. Patients taken consecutively from the waiting lists for clinic appointments, were sent a letter explaining the asynchronous virtual clinic process and given a date and time to come for measurement of visual acuity, intraocular pressure as well as Humphrey visual field testing and OCT of the optic disc. Medication was recorded. Nurses and health care workers were trained to undertake all these tests. All the patients’ results were put onto a specifically designed proforma, visual fields printed and collected, OCTs were digitally stored, and all reviewed by the Ophthalmologist. The Ophthalmologist went through the virtual clinical data comparing where possible with previous data and decided on management options 1) patient stable - see 1 year, 2) some changes but eye pressure stable or no previous data found for example unsure of age of visual field defect, see in 6 months, 3) Patients with high IOPs are booked into the next available clinic for urgent management. Patients are written to with the outcome of their clinic and a copy sent to their GP and optometrist.
Results: Over 1 year 112 patients were seen in the asynchronous virtual clinics. 109 of the patients seen had glaucoma, 3 had uveitis and were not included in the data analysis. Of the 109 patients the vast majority had chronic open angle glaucoma, with 10 narrow angle/closed angle, 8 ocular hypertensives and 2 uveitic glaucoma. Of these patients 35 were stable and given an appointment to be reviewed in a year. 35 patients were to be seen again in 6 months rather than 1 year due to problems with assessment, such as no previous visual field for comparison, but eye pressures were controlled. 39 patients were asked to come into the next clinic to be seen by the Ophthalmologist as their IOP was too high or there were concerns about increasing visual field loss. When the management was changed the patient was booked into the eye clinic in approximately 2 months for an IOP check.
Conclusion: The asynchronous virtual clinic is a way of maintaining regular review for significant numbers of patients that can be seen and managed and has the safety net that patients can be reviewed urgently if necessary

Keywords:Asynchronous; Virtual clinic; Glaucoma; Ocular morbidity; Health; Humphrey visual; Optometrist; Chronic

Abbreviations:SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus-2; IOP: Intra Ocular Pressure; VF: Visual Field