Bobeck S Modjtahedi,1,2 Katherine Chu,1 Tiffany Q Luong,2,3 Chunyi Hsu,2,3 Cynthia Mattox,4 Paul P Lee,5 Mamdouh L Nakla,6 Donald S Fong1–3
1Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA; 2Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA; 3Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA; 4New England Eye Center, Tufts University School of Medicine, Boston, MA, USA; 5Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA; 6Department of Ophthalmology, Southern California Permanente Medical Group, South Bay Medical Center, Harbor City, CA, USA
Purpose: The purpose of this study was to characterize a pilot program using e-health to monitor glaucoma suspects in a large integrated health system.
Methods: A retrospective chart review of patients enrolled in the first 2 years of a new glaucoma suspect telemedicine monitoring program was conducted. Patients were enrolled in the program after being diagnosed as glaucoma suspects in the regular clinic setting and were eligible for the program if they had better than 20/40 vision, intraocular pressure (IOP) <25 mmHg, a normal baseline visual field, and an optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) without clear evidence of glaucomatous optic nerve damage. Patients were followed annually thereafter with measurements of vision, IOP, and OCT RNFL, which were reviewed at a centralized telemedicine reading center. Patients were retained within the program unless there was evidence of disease progression, in which case they were referred to an ophthalmologist for further evaluation. The first 100 patients received a survey assessing their satisfaction with the program after their first visit. The number of patients who adhered to follow-up recommendations, who were referred to an ophthalmologist for additional evaluation, and who began on IOP-lowering medications was evaluated.
Results: A total of 225 patients were enrolled in this program. Of eligible patients, 97.3% attended their 1-year follow-up visit and 92.5% attended their 2-year follow-up visit. Over the course of 2 years, five patients were referred for further clinic evaluation due to concern for progressive RNFL loss, of which two were started on IOP-lowering medications. No patients were referred to the clinic for vision loss or elevated IOP. In all, 87% of patients said that they would be extremely or quite likely to recommend the program to a friend. More than 80% of patients said that the program was extremely or very helpful, convenient, and professional.
Conclusion: This novel telemedicine program for monitoring low-risk glaucoma suspects achieved high patient retention. Significant disease progression was rare with a few patients requiring referrals back to the clinic setting or initiation of IOP-lowering therapy. Telemedicine is a promising method to follow patients who are glaucoma suspects.
Keywords: e-health, glaucoma, optical coherence tomography, retinal nerve fiber layer, telemedicine, teleophthalmology