Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT01899963 |
| Other study ID # |
Tele-retinal Referral T.T.T. |
| Secondary ID |
|
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
November 2013 |
| Est. completion date |
February 2022 |
Study information
| Verified date |
May 2023 |
| Source |
McMaster University |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
In this province, optometrists are often responsible for contacting the retinal specialists'
office to arrange patients to be examined for suspected emergencies or more routine referrals
related to the eye. This is often done by faxing a referral form to the specialists' office,
where the retinal specialist will examine the information presented in the referral form and
make a decision on when the patient should be seen. This current method has some important
considerations, such as the difficulty of transmitting clear images of the back of the eye
over fax. Having this information could help the retinal specialist in determining when the
patient should be seen, especially in terms of booking additional tests or when treatment
should be given.
Teleophthalmology is a branch of telemedicine that delivers eye care through digital
equipment and telecommunications technology. It offers some unique advantages, such as the
ability to be integrated with electronic health records, the ability to be viewed by multiple
members of the health care team, and potentially reduce wait times and travel times to the
ophthalmologist.
However, there is no comparison known to the study team between whether patients being
referred from optometrists to retina specialists through a teleophthalmology system will be
treated earlier than patients through a conventional fax system. This study aims to examine
and provide more information on this topic.
Description:
Within the province of Ontario, there are a limited number of retinal specialists for a large
and geographically diverse population of 13.5 million people in 2012. Because the majority of
these specialists are located in larger urban centers, many rural patients have difficulty
travelling the significant distance from their communities to the city. Currently in Ontario
optometrists are responsible for triaging retinal eye diseases; emergency referrals such as
endophthalmitis are organized by same-day telephone consultations, while more routine
referrals are scheduled by fax.
This current method of triage has particular important considerations. Because of the limited
number of retinal specialists long wait times can lead to permanent vision loss if the
referral is inaccurate, where the patient should have been seen and treated sooner instead of
later such as the case of wet age-related macular degeneration (wAMD) and Diabetic Macular
Edema (DME). In addition, essential vision tests such as fluorescein angiography (FA) are
often available only in a hospital setting rather within physician or optometrists' office.
For patients from rural or remote communities, this inconvenience could result in lost wages,
a long return trip back the next day or even an overnight stay.
Teleophthalmology is a branch of telemedicine that delivers eye care through digital
equipment and telecommunications technology. It offers some unique advantages, such as the
ability to be integrated with electronic health records, the ability to be viewed by multiple
members of the health care team, and potentially reduce wait times and travel times to the
ophthalmologist. Within Canada, there have been different teleophthalmology initiatives to
provide access to specialists to optometrists and primary care practitioners particularly in
rural and remote areas, improving ophthalmologic care and reducing unnecessary patient travel
expenditures. These teleophthalmology systems can include fundus and Optical Coherence
Tomography (OCT) images to aid the ophthalmologist in more accurately diagnosing and triaging
the referral. Hanson et al. in a retrospective case series noted that tele-referrals to
retinal specialists from optometrists reduced average travel time, travel distance and the
number of office visits to retina specialists while improving efficiency of clinical
examination, testing, and treatment.
However, there currently is no research known to the study team that actively compares the
time to treatment for patients based on teleophthalmology referral and assessment versus a
conventional paper referral system from optometrists to retinal specialists. For conditions
like wAMD and DME related to Diabetic Retinopathy that are often referred via
teleophthalmology, the difference in time to treatment could prevent vision loss. The
inclusion of fundus and OCT images in teleophthalmology could also improve triage accuracy
and prioritization of referrals and appointments to the retinal specialist. This study
focuses on comparing the time to treatment for a tele-retinal referral system to a paper
referral system by focusing on two prevalent retinal conditions: wet AMD and DME. The results
could demonstrate that tele-ophthalmology can reduce the time to treatment for patients with
wet AMD and DME in Ontario, improving access to retinal specialists and allowing for more
efficient triage of patients.
