Time to treatment - A tele-retinal referral system for wet age-related macular degeneration and diabetic macular edema

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Authors: Jenny Qian, Joshua Barbosa, Varun Chaudhary
Author Disclosure Block: J. Qian: None. J. Barbosa: Grant/research support; Bayer, Fight for Sight, Novartis, Allergan. V. Chaudhary: Grant/research support; Novartis, Bayer, Allergan. Employment/honoraria/consulting fees; Novartis, Bayer. Membership on an advisory panel, standing committee or board of directors; Novartis, Bayer.

Abstract Body:

Purpose: Optometrists are responsible for triaging retinal eye diseases in Ontario. However, the limited number of retinal specialists mean long wait times; this can lead to vision loss if the referral is inaccurate in cases where the patient should have received treatment sooner. This study compares the time-totreatment for patients based on teleophthalmology referral versus a conventional paper referral system for wet age-related macular degeneration (wAMD) and diabetic macular edema (DME).

Study Design: A single-centered, prospective observational study.

Methods: Ethics approval was obtained from the local Research Ethics Board. Optometrist referrals were sent to a Hamilton retinal specialist by fax or tele-referral (secure email). Tele-referrals included fundus and/or optical coherence tomography (OCT) images. The time-to-treatment - time from when the retinal specialist reviewed the referral to when the patient received treatment - was compared between groups.

Results: Out of 50 participants (64 eyes), the majority were wAMD referrals: 23 tele-referrals and 14 from fax. Patients referred by tele-referral lived an average 28.42 ± 26.28 km from the eye clinic, and 16.88 ± 11.02 km for fax referrals (p < 0.05). It was 1.9 ± 1.9 days from tele-referral to specialist review and 0.25 ± 0.5 days from fax referral to review (p < 0.01). 48.3% of tele-referred patients required treatment compared to 38.1% from fax (p < 0.05). Time-to-treatment was 28.8 ± 13.7 days in telereferred patients and 60.6 ± 15.4 days for fax patients (p < 0.01). The time from referral to treatment for tele-referrals was 32.3 ± 15.2 days and 61.9 ± 15.5 days for fax referrals (p < 0.01). The number of visits was similar between groups (1.8 ± 0.5 for tele-referrals and 1.9 ± 0.4 for fax) but less tests were ordered for tele-referred patients (1.4 ± 0.7 tests versus 2.0 for fax).

Conclusions: The time from referral to review was longer for tele-referrals, but time-to-treatment and time from referral to treatment was shorter. The tele-referrals provided more detailed information with the inclusion of testing images. As a result, the tele-referral group had improved diagnostic accuracy as a greater proportion of tele-referred patients required treatment and improved efficiency as less testing at the eye clinic was performed. While larger studies are required, these results demonstrate the potential of teleophthalmology referral systems to provide benefits for healthcare providers and their patients.