Are all remote eye exams equal?
Tele-otometry increased significantly during the Covid-19 pandemic. With customers being unable to travel and social distancing stopping people interacting, it was impossible to carry out an eye examination. As a result, especially for contact lens checks, patients would send images of their eyes, taken with smartphones, to their practitioner, who would make a judgement on the health of the eye and provide a repeat order. Similarly, diagnosis of minor eye conditions was carried out in the same way.
I think we all accept that this was not ideal, but it was a needs-must solution to an unprecedented problem. Since then, tele-optometry solutions have developed, and the use gained traction and support with it being seen as the solution to providing eye care to areas underserved with optometrists or to increase volume through a store. Types of remote eyecare can be described as synchronous or asynchronous and practitioner controlled or uncontrolled.
Figure 1 – Types of remote eyecare and the associated risk levels:
Red: High Risk Yellow: Medium Risk Green: Low Risk
Figure 1 shows the different types of remote examination, and the potential risk levels that may be associated with them.
Tele-otometry increased significantly during the Covid-19 pandemic. With customers being unable to travel and social distancing stopping people interacting, it was impossible to carry out an eye examination. As a result, especially for contact lens checks, patients would send images of their eyes, taken with smartphones, to their practitioner, who would make a judgement on the health of the eye and provide a repeat order. Similarly, diagnosis of minor eye conditions was carried out in the same way.
I think we all accept that this was not ideal, but it was a needs-must solution to an unprecedented problem. Since then, tele-optometry solutions have developed, and the use gained traction and support with it being seen as the solution to providing eye care to areas underserved with optometrists or to increase volume through a store. Types of remote eyecare can be described as synchronous or asynchronous and practitioner controlled or uncontrolled.
The Patient Journey
Usually, once a patient has been booked into the store, the journey begins.
We start with a brief history and symptoms which are recorded by a technician and read by the practitioner, who can delve into more detail when they start the remote exam.
Pre-screening usually involves a number of different tests, such as
- Auto refraction
- Non-Contact Tonometry
- Fundus imagery
- Ultra Widefield fundus imagery
- OCT
All of the are carried out by a trained technician. This type of data capturing has something in common; it is not dynamic. In all cases they are a point-and-shoot capture system and for the most part, the devices that are used are set up in such a way that the device controls when the data is captured to ensure the best possible image or result. In short, it is hard to get wrong.
At this point there is a divergence depending on whether the remote exam is synchronous, asynchronous, controlled, or uncontrolled.
In an asynchronous examination a technician will now image the anterior segment of the eye. Either using a digital slit lamp and recording the exam for later review by the practitioner or using a handheld imaging device, an asynchronous, uncontrolled anterior examination. This patient will then be seen by a remote practitioner who will review the information, carry out a remote refraction, and make a clinical decision. All based on data collected by others.
Alternatively, the patient is taken into the test room and the doctor joins remotely, does the remote refraction, and then the technician carries out a slit lamp examination with the practitioner watching a live stream of the exam and trying to guide the technician to view certain structures or areas of the eye. A synchronous uncontrolled examination, which is an improvement over the first option, but still gives room for missed pathology, delayed diagnoses, delayed therapy, and frustrated practitioners.
The final option is a controlled and synchronous examination of the anterior segment. In this version the patient is joined by the remote practitioner and the information reviewed, a remote refraction carried out and then the practitioner remotely controls a specialised slit lamp to carry out a full controlled anterior segment examination of the eye, exactly as they would do if they were in the room with the patient. Able to view the eye in high quality video control the light, slit, ocular, and filters in the same way as a traditional slit lamp. This is synchronous and controlled tele optometry and this is the version that provides the greatest level of care to a patient and protection to a practitioner. It gives the same level of control to the practitioner as they would have if they were in person. It should always be remembered that a practitioner can delegate a task, but they cannot delegate responsibility. If a pathology is missed, if treatment is delayed, if harm occurs because something wasn’t picked up in an image taken by someone other than the practitioner, the practitioner remains responsible for that.
A slit lamp examination of the eye is a dynamic examination that goes beyond positioning the light and the oculars in a certain way. It combines technique with anatomical and physiological knowledge to build up a picture of the health of a patient’s eye.
The ability to capture still images and videos in real-time for review, referral or record-keeping will greatly enhance the diagnosis and treatment of ocular issues or pathologies. Being able to share the images or video with the patient at the time of the examination, would also aid patient compliance and understanding.
Today there is only one way to carry out that examination in a synchronous and controlled way, and that is with Aetheia from Eyoto. The only remote slit lamp capable of providing the same level of care to a patient and the protection to a practitioner as being there.
For more information on Aetheia click here.