Diabetic Eye Care Providing the Best Care in a Virtual Environment

Alot of us had virtual clinics before COVID but keeping our patients and staff safe during COVID made us rethink our clinical pathways,” Tunde Peto MD, PhD told the virtual session, “Better Patient Counselling: Using Epidemiological Evidence in Day-to-Day Clinical Practice.”

Dr Peto’s presentation provided details on how clinicians might best reduce patient time in the clinic and thus chances of COVID-19 infection while still providing top-notch care. She can speak from experience: besides working as a professor of clinical ophthalmology, Dr Peto is also the clinical lead for diabetic eye screening in Northern Ireland.

“Diabetic eye disease-related blindness is still on the rise by 8% per year, representing a very real problem for patients, caregivers, and society at large,” she reminded delegates.

As such, it is worthwhile to study the details of diabetic eye care during the pandemic. Further, diabetes mellitus is a risk factor for a more severe disease course, so avoiding infection is of utmost importance. The clinical pathways patients with diabetes must travel bring them in contact with many people, each of whom may be a source of contamination.

“What are the prerequisites for these redesigned clinical pathways? Do you have enough space, time, and trained personnel to take the images? Do you have suitably qualified, trained personnel to assess the images using a set protocol and communicate the results to the patients? And do you have dedicated time to read and analyse the images?” she asked.

Dr Peto also reminded the audience discussing these potential changes with the relevant legal team is essential, especially if implementing artificial intelligence as part of the pathway.

Upgraded equipment might even be necessary when switching from funduscopic examination at the slit lamp to imaging modalities. While many practices have fundus cameras for photographing the posterior pole, more than 10% of patients with diabetic retinopathy have clinically relevant severe disease only visible on wide-field imaging, Dr Peto said.

Appropriate triage of patients is also crucial. “Patients requiring urgent lasers or injections are not suitable for virtual clinics,” she said, as these cannot be performed virtually or with any form of social distancing.

For the remaining patients, limiting time in the clinic should be a primary goal. Dr Peto offered several suggestions, such as ringing the patient before their visit to take relevant history over the phone and having clear protocols in place for imaging so that all staff knows the requirements in all situations, such as a protocol for those patients with ungradable images.

Dr Peto urged candidates to be inventive.

“For example, use handheld cameras in dialysis clinics to identify and subsequently prioritise high-risk patients,” she suggested. “After all, 38% of patients with diabetes say that long wait times for an appointment were a barrier to eye exams.

“Well-planned, evidence-based services are the only way to prevent blindness due to diabetic eye disease,” she concluded.