Improving Access and Reducing the Burden on Public Ophthalmology: Collaborative Telehealth Models Between...

Collaborative care between optometry and ophthalmology has demonstrated the potential to improve timely access to care. This study examines three settings where real-time optometry-facilitated telehealth was used to expedite specialist eye care in rural and remote Western Australia. Referrals to ophthalmology were triaged to telehealth or face-to-face services. For telehealth, optometrists performed a comprehensive in-person assessment, then facilitated video-consultation with an ophthalmologist during the same attendance for collaborative decision making.

In 2023, retrospective chart review was undertaken for ophthalmology services in towns more than 1500 km from the capital city. Optometrists performed comprehensive in-person assessments and facilitated telehealth in three settings: hospital, community clinic and visiting outreach. Attendance rates were compared between collaborative telehealth and face-to-face ophthalmology. Follow up outcomes and diagnoses for telehealth consultations were reported.

A total of 1876 non-surgical ophthalmology episodes of care were delivered in the 12-month period, of which 1044 (55.7%) were delivered by optometry using telehealth. Of those managed by telehealth, only 83 episodes of care required a subsequent face-to-face ophthalmology consultation. The hospital setting provided the greatest proportion (76.4%) of telehealth. Adjusted logistic regression showed the odds of attendance were 3.6 (95% CI: 2.6-5.0) times higher for telehealth appointments than face-to-face (p < 0.001). Surgical rates of outreach ophthalmology were high (30.0 to 74.1% of activity). Common diagnoses in telehealth included cataract, pterygium for direct surgical booking and chronic conditions (glaucoma, diabetic retinopathy) for instituting appropriate management.

Collaborative telehealth with optometry improves access to ophthalmology services in rural Australia and should be considered in metropolitan settings and other countries.