The Impact of the COVID-19 Pandemic on Tele-ophthalmology-Based Retinal Screening

• Published in: Ophthalmology and therapy Vol. 13; no. 9; pp. 2467 - 2480
• Main Authors: Rasmussen, Marie L. R., Cehofski, Lasse J., Davies, Julie, Faber, Carsten, Falk, Mads K., Grauslund, Jakob, Hansen, Michael S., Keane, Pearse A., Natarajan, Sundaram, Peto, Tunde, Subhi, Yousif, Wykoff, Charles C., Muttuvelu, Danson V.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.09.2024; Adis, Springer Healthcare
• Subjects: COVID-19; Healthcare organization; Internal Medicine; Medicine; Medicine & Public Health; Ophthalmology; Original Research; Retinal screening; Tele-ophthalmology; COVID-19; Retinal screening; Tele-ophthalmology; Healthcare organization
• ISSN: 2193-8245; 2193-6528
• DOI: 10.1007/s40123-024-01008-8

Introduction This study reports our experiences with systematic retinal screening in Denmark through optometrists with access to tele-ophthalmological services before, during, and after the COVID-19 pandemic. Methods We evaluated an optometrist-based retinal screening system with a referral option for tele-ophthalmological service by a consultant ophthalmologist within the time period of August 1, 2018 to September 30, 2023. The optometrist collected patient history, refraction, best-corrected visual acuity, intraocular pressure, basic slit-lamp examination, 4-in-1 visual field report, and retinal imaging using color fundus 45° photography. Tele-ophthalmological services were provided by consultant ophthalmologists. Within pre-defined periods of pre-COVID-19, COVID-19, and post-COVID-19, we evaluated the rate of referrals to the tele-ophthalmological service, diagnoses made, and referrals to the public healthcare system. Results A total of 1,142,028 unique individuals, which corresponded to 19.1% of the entire population of Denmark, underwent screening by the optometrists; 50,612 (4.4%) of these individuals were referred to the tele-ophthalmological examination by consultant ophthalmologists. A referral for further ophthalmic examination, either at hospital or at an ophthalmic practice, was made for 10,300 individuals (20.4% of those referred for tele-ophthalmology, corresponding to 0.9% of the population screened). The referral rate from the screening to the tele-ophthalmological service increased from before COVID-19 (3.4%) to during COVID-19 (4.3%) and further after COVID-19 (6.4%). This increase coincided with an increasing prevalence of conditions seen in the tele-ophthalmological service. Conclusion During a period of 5 years, 19.1% of the entire population of Denmark underwent retinal screening. This provided an adjunctive health service during a period of severe strain on the public healthcare system, while limiting the number of excessive referrals to the public healthcare system. Temporal trends illustrated an increased pattern of use of a large-scale tele-ophthalmological system.