Abstract
Background
Given the increasing prevalence of diabetes and diabetic retinopathy (DR) in the UK, this study evaluates a novel primary care optometry-based DR review service against traditional hospital-based virtual DR clinics.
Methods
In the hospital-based virtual DR service, patients attended for data capture (visual acuity, fundus photography, macular OCT scanning) with asynchronous review at a later data by a hospital clinician. In the primary care optometry DR review clinic, patients attended an optometry practice for a face-to-face(F2F) review (with imaging) by an optometrist with additional training in DR. Data from both clinic types were analysed. Metrics included DR grading, management plans, grading concordance between primary care optometrists and consultant ophthalmologists, and the assessment of “ungradable” retinopathy referrals.
Results
One thousand seven hundred and sixty patients attended the virtual clinic between January 2021 and September 2023. 954 patients attended the primary care review clinic between August 2022 and September 2023. Grading agreements between primary care optometrists and hospital consultants on those patients referred for consultant opinion were significant with Weighted Kappa scores of 0.61(95% CI 0.52–0.69) for DR grade and 0.69(95% CI 0.56–0.82) for diabetic macular oedema (DMO) status. Additionally, the primary care optometry clinic reported a considerably reduced non-attendance rate of 5%, in contrast to 21% in virtual clinics.
Conclusion
The primary care optometry-based DR service emerges as an efficient, safe alternative to hospital services. It offers notable advantages over virtual clinics and addresses a care gap for those unsuitable for virtual consultations. The results highlight the potential of primary care-based models in managing DR.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 18 print issues and online access
$259.00 per year
only $14.39 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fs41433-024-03211-0/MediaObjects/41433_2024_3211_Fig1_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fs41433-024-03211-0/MediaObjects/41433_2024_3211_Fig2_HTML.png)
Similar content being viewed by others
Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request
References
Talks SJ, Gupta R, Buckley S. The incidence of diabetic retinopathy requiring treatment is also low in the under 90 age group. Eye. 2016;30:1146.
Kanji A, Jojo V, Schmermer S, Connor C, Mann SS. Managing patients with early diabetic maculopathy via virtual SD-OCT clinics. Diabetic Eye J. 2015;4:34–8.
Lee JX, Manjunath V, Talks SJ. Expanding the role of medical retina virtual clinics using multimodal ultra-widefield and optical coherence tomography imaging. Clin Ophthalmol. 2018;12:2337–45.
Kortuem K, Fasler K, Charnley A, et al. Implementation of medical retina virtual clinics in a tertiary eye care referral centre. Br J Ophthalmol. 2018;102:1391–5.
Juaristi L, Irigoyen C, Chapartegui J, Guibelalde A, Mar J. Assessing the utility and patient satisfaction of virtual retina clinics during COVID-19 pandemic. Clin Ophthalmol. 2022;16:311–21.
Veeramani P, Pilar Martin-Gutierrez M, Agorogiannis E, et al. Efficacy and Safety outcomes of a novel model to assess new medical retina referrals in a high-volume medical retina virtual clinic. Eye. 2023. https://doi.org/10.1038/s41433-023-02653-2.
El-Khayat AR, Anzidei R, Konidaris V. Ophthalmic photographer virtual clinics in medical retina. Int J Ophthalmol. 2020;13:677–80.
Lois N, Cook JA, Wang A, et al. EMERALD Study Group. Evaluation of a new model of care for people with complications of diabetic retinopathy: the EMERALD Study. Ophthalmology. 2021;128:561–73.
Author information
Authors and Affiliations
Contributions
KG conceived the idea for the study, DD/AA/KG collected and analysed data, KG/DD drafted the manuscript. All authors provided critical review of the manuscript and approved the final version.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Dorrian, D., Al-Janabi, A. & Gallagher, K. Primary care optometry-based diabetic retinopathy review clinics – a new model of care and comparison with virtual diabetic retinopathy clinics. Eye (2024). https://doi.org/10.1038/s41433-024-03211-0
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41433-024-03211-0