title: Teleophthalmology with optical coherence tomography imaging in community optometry. Evaluation of a quality improvement for macular patients.
abstract: OBJECTIVE
  To describe a quality improvement for referral of National Health Service patients with macular disorders from a community optometry setting in an urban area.
  
  
  METHODS
  Service evaluation of teleophthalmology consultation based on spectral domain optical coherence tomography images acquired by the community optometrist and transmitted to hospital eye services.
  
  
  RESULTS
  Fifty patients with suspected macular conditions were managed via telemedicine consultation over 1 year. Responses were provided by hospital eye service-based ophthalmologists to the community optometrist or patient within the next day in 48 cases (96%) and in 34 (68%) patients on the same day. In the consensus opinion of the optometrist and ophthalmologist, 33 (66%) patients required further "face-to-face" medical examination and were triaged on clinical urgency. Seventeen cases (34%) were managed in the community and are a potential cost improvement. Specialty trainees were supervised in telemedicine consultations.
  
  
  CONCLUSIONS
  Innovation and quality improvement were demonstrated in both optometry to ophthalmology referrals and in primary optometric care by use of telemedicine with spectral domain optical coherence tomography images. E-referral of spectral domain optical coherence tomography images assists triage of macular patients and swifter care of urgent cases. Teleophthalmology is also, in the authors' opinion, a tool to improve interdisciplinary professional working with community optometrists. Implications for progress are discussed.
authors.affiliation: Ophthalmology Department, Royal Bolton Hospital National Health Service Foundation Trust, Bolton, UK.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kelly
authors.forename: Ian
authors.initials: I
authors.lastname: Wallwork
authors.forename: David
authors.initials: D
authors.lastname: Haider
authors.forename: Kashif
authors.initials: K
authors.lastname: Qureshi