“Teleophthalmology has been a great addition to community optometry”
Optometrists John Keenan and Linda Hunter share their experiences of using video consulting technology in Scotland
A patient presenting with a potentially serious eye condition would have once created a real challenge for Alloa-based optometrist John Keenan, not just in terms of the precise clinical care required, but also in terms of managing his busy clinic.
But the introduction of video consulting technology by NHS Forth Valley has reinforced Mr Keenan’s sense of confidence in his ability to handle clinically challenging cases with a specialist opinion just a video call away.
“You can virtually invite an ophthalmologist into the room to look over your shoulder,” Mr Keenan said.
“I am not only learning but I am also gaining confidence in my clinical ability. Every day is a school day in optometry; which is even more the case when you are getting to partner up with an ophthalmologist who is examining the patient with you,” he elaborated.
A digital slit lamp combined with the Attend Anywhere software gives the optometrist the tools they need to participate in teleophathlmology.
Alternatively, a 3D-printed adaptor can be added to a smartphone or tablet. This effectively connects the device to the optometrist's slit lamp, which in turn gives the consultant ophthalmologist a high definition view of the patient’s eye.
The University of Strathclyde technology is combined with the Attend Anywhere video consultation platform, which has been rolled out across Scotland and piloted or adopted by 40 NHS trusts in England and Wales.
The ophthalmologist often likes to converse with the patient and ask some questions that perhaps I would not have thought to ask. The patients have found it very engaging and novel
Mr Keenan emphasised that the ability to show an ophthalmologist a patient’s eye rather than describe what he is seeing is invaluable.
“It is sometimes difficult to describe a clinical condition to a specialist over the phone. Showing the ophthalmologist a picture perhaps via email is great if you can do that but sharing a high definition video feed of what you are looking at is the pinnacle for me,” he said.
Mr Keenan highlighted that patients have responded very positively to the experience, which becomes a three-way consultation between the patient, the optometrist and the ophthalmologist.
“The ophthalmologist often likes to converse with the patient and ask some questions that perhaps I would not have thought to ask. The patients have found it very engaging and novel,” he said.
Mr Keenan highlighted that optical coherence tomography (OCT) screen mirroring is a useful aspect of the technology, given the increasing use of OCT devices within optometry.
“Screen mirroring will allow an ophthalmologist to view the complete OCT scan in its entirety using teleophthalmology and be able to pass judgement on the eye conditions that the scans are showing us,” he elaborated.
The Specsavers Alloa optometrist qualified 15 years ago. He is quick to point out the potential value of the technology for less experienced practitioners.
“I can only imagine, thinking back to when I was newly qualified, what this technology would have meant. It would have made my working life much less stressful,” he observed.
Originally video calls from community optometry to secondary care in Scotland using the Attend Anywhere platform were made on a pre-planned basis with the optometrist and ophthalmologist having to schedule a specific time to connect.
However, NHS Forth Valley have recently made the service live Monday to Friday between 9am and 5pm. This means video calls can be put through without pre-arrangement.
Around 40 calls have been made by Mr Keenan and his colleagues at Specsavers Alloa using the system over the past year.
“Looking ahead, the number of calls being made is likely to increase without the need for prior arrangement of calls,” Mr Keenan said.
Alloa-based optometrist, Linda Hunter, has also been using Attend Anywhere at her independent practice LA Hunter Optometrists.
After recently completing an independent prescribing qualification, Ms Hunter has found the video consultation platform to be particularly valuable.
“If I am unsure about either a diagnosis or what to prescribe, I can access a second opinion without unduly inconveniencing either the patient or ophthalmologist,” Ms Hunter said.
Sharing an example of how the technology can provide care closer to home, Ms Hunter described a case where a young boy presented with suspected acute dacryocystitis.
Because the patient was a child, guidelines suggested an emergency referral although the condition was not severe.
“After a teleophthalmology consultation, I supplied the boy with a course of chloramphenicol which cleared the condition avoiding a visit to hospital,” Ms Hunter shared.
I can access a second opinion without unduly inconveniencing either the patient or ophthalmologist
The independent optometrist told OT she often uses the technology to arrange for a second opinion on an OCT scan.
“This can be arranged at a suitable time, it doesn’t have to be when the patient is present. The ophthalmologist can then view a full volume scan and triage how soon a patient needs to be seen,” Ms Hunter highlighted.
She observed that as well as making treatment pathways more efficient, video consulting can provide straightforward advice and reassurance to patients.
“Teleophthalmology has been a great addition to community optometry. It means that some patients can avoid a trip to hospital and ophthalmologists don’t have their clinics clogged up with avoidable referrals,” Ms Hunter shared.