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

Marie L R Rasmussen; Lasse J Cehofski; Julie Davies; Carsten Faber; Mads K Falk; Jakob Grauslund; Michael S Hansen; Pearse A Keane; Sundaram Natarajan; Tunde Peto; Yousif Subhi; Charles C Wykoff; Danson V Muttuvelu

doi:10.1007/s40123-024-01008-8

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

Ophthalmol Ther. 2024 Sep;13(9):2467-2480. doi: 10.1007/s40123-024-01008-8. Epub 2024 Aug 2.

Authors

Marie L R Rasmussen^{1

2}, Lasse J Cehofski^{3

4}, Julie Davies⁵, Carsten Faber^{1

2}, Mads K Falk^{2

6}, Jakob Grauslund^{7

8

9}, Michael S Hansen^{1

2}, Pearse A Keane¹⁰, Sundaram Natarajan¹¹, Tunde Peto¹², Yousif Subhi^{1

6

7}, Charles C Wykoff^{13

14}, Danson V Muttuvelu^{15

16}

Affiliations

¹ Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
² Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³ Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark.
⁴ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁵ Global Business School for Health, University College London, London, UK.
⁶ Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.
⁷ Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁸ Department of Ophthalmology, Odense University Hospital, Odense, Denmark.
⁹ Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway.
¹⁰ NIHR Biomedical Research Centre at Moorfields, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
¹¹ Aditya Jyot Eye Hospital Pvt. Ltd., Mumbai, Maharashtra, India.
¹² Centre for Public Health, Queen's University Belfast, Belfast, UK.
¹³ Retina Consultants of Texas, Houston, TX, USA.
¹⁴ Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
¹⁵ Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. dansonvm@gmail.com.
¹⁶ MitØje V/ Danske Speciallæger, Ferdinand Salling Stræde 2, 1, 8000, Aarhus C, Denmark. dansonvm@gmail.com.

Abstract

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.

Keywords: COVID-19; Healthcare organization; Retinal screening; Tele-ophthalmology.