Glaucoma Suspect Monitoring: Can Telemedicine Bridge the Gap?
"A pilot program reveals how e-health solutions are keeping low-risk glaucoma suspects on track, reducing clinic burden and enhancing patient satisfaction."
For individuals suspected of having glaucoma, regular monitoring is essential. However, this can be time-consuming and costly for both patients and healthcare providers. Traditional diagnostic methods rely on a combination of subjective and objective ophthalmic testing, including clinical examinations and retinal nerve fiber layer (RNFL) measurements using optical coherence tomography (OCT). These tests help identify characteristic changes in optic nerve morphology, which are crucial for early detection and management.
Glaucoma suspects often present a unique challenge, as they exhibit an increased risk of developing the disease but do not yet show definitive signs requiring immediate intervention. These individuals may have suspicious optic nerve appearances, abnormal visual fields, and/or elevated intraocular pressure (IOP). Managing these patients requires careful monitoring, which can be resource-intensive, particularly when access to ophthalmologists is limited.
Telemedicine offers a promising solution to overcome these challenges. By extending healthcare delivery through digital channels, telemedicine can enhance routine screening and monitoring of ophthalmic pathologies. A pilot project was launched in 2013 at the Kaiser Permanente Eye Monitoring Center (EMC) to assess the feasibility and effectiveness of monitoring low-risk glaucoma suspects via telemedicine. This article delves into the program's initial two-year experiences, evaluating patient adherence, retention rates, and overall outcomes.
Telemedicine Monitoring Program
The Kaiser Permanente Eye Monitoring Center (EMC) initiated a pilot project in 2013 to monitor low-risk glaucoma suspects. The initial 2-year experiences of this program are described herein to evaluate patient adherence/retention and to demonstrate a proof of concept.
- In the program, patients could be enrolled if they had 20/40 or better vision, an IOP <25 mmHg, and a normal baseline visual field without evidence of glaucomatous optic nerve damage (and no sectors in the red color code) on OCT RNFL.
- Each patient's eligibility was evaluated by a glaucoma specialist and following approval they were enrolled in the program.
- Patients would receive an appointment at a local ophthalmology office where vision, IOP (via handheld applanation tonometer), and OCT RNFL were taken by a technician annually.
- These findings were forwarded to and screened by a trained technician at a centralized telemedicine reading center where they were compared to prior visits.
The Future of Glaucoma Care
Telemedicine programs offer a promising approach to alleviate the strain on the healthcare system amidst a growing demand for ophthalmic care, particularly as societies age. Early stages of glaucoma are well-suited for telemedicine due to the disease's slow progression, where small, incremental changes are less likely to cause significant visual impairment in the early phases. By leveraging technology and innovative care models, telemedicine can enhance access, improve patient outcomes, and optimize resource utilization in glaucoma management.