title: Ophthalmic digital image transfer: benefits to triage, patient care and resource.
abstract: OBJECTIVE
  Hospital capacity in the UK is currently significantly challenged due to new treatments, targets and resource limitations. There have been significant improvements in training, equipment and shared care services in community primary care optometry services. Despite this the challenges to ophthalmic service delivery are considerable. One area of potential benefit is the effect on outcome when a clinical image is attached to a referral. We aimed to quantify the effect of attaching digital images to ophthalmic referrals.
  
  
  METHODS
  Retrospective analysis of 358 consecutive optometry referrals to the Hospital Eye Service in Dunfermline, Scotland using electronic referral with digital images. All images were screened by consultant ophthalmologists.
  
  
  RESULTS
  The patients were aged between 9 and 100 years (mean age 63.6 years). Sixty four (18%) referrals were deemed urgent (requiring appointment within 24-60 h), with the majority, 28 (8%) being wet macular degeneration. One hundred and seventy (48%) were deemed routine (appointment within 2-6 weeks), with categories including macular disease, glaucoma, cataract, optic disc and retinal abnormalities. Twenty seven (8%) patients were already attending the hospital eye service, or had been referred previously for the same condition. Categories were mainly glaucoma, diabetic retinopathy and cataract. Ninety-five (25%) were 'e-diagnosed' based on image and referral information (i.e. with no secondary eye care appointment). Diagnosis included glaucoma suspect (22, 6%), macular pathology (12, 3%), abnormal looking discs (9, 2.5%) and cataract (9, 2.5%). The overall 'did not attend' rate for those patients seen in the hospital eye service (254) was <1% (two patients).
  
  
  CONCLUSIONS
  The attachment of digital images improved the quality of referral triaging from optometry to secondary eye care in the hospital eye service. It allowed detection of sight threatening disease early and more appropriate allocation of patients to specific specialist clinics at first visit. They allowed safe and speedy 'e-diagnosis' of a subgroup, saving hospital capacity and minimising patient inconvenience. Indirectly the service also reduced the 'did not attend' rate. With recent improvements in camera and internet technology digital images will have an ever increasing role in secondary eye care as it continues to adapt to meet modern demands.
authors.affiliation: Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Scotland, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Goudie
authors.forename: David
authors.initials: D
authors.lastname: Lunt
authors.forename: Suzanna
authors.initials: S
authors.lastname: Reid
authors.forename: Roshini
authors.initials: R
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005128:Eye Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009907:Optometry / Q000592:standards*; D005791:Patient Care / Q000592:standards*; D017060:Patient Satisfaction; D010781:Photography; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012606:Scotland; D014218:Triage / Q000592:standards*; D055815:Young Adult
keywords: digital; images; referrals; triage