title: Virtual clinics in glaucoma care: face-to-face versus remote decision-making.
abstract: To examine the agreement in clinical decisions of glaucoma status made in a virtual glaucoma clinic with those made during a face-to-face consultation.
  
  
  
  A trained nurse and technicians entered data prospectively for 204 patients into a proforma. A subsequent face-to-face clinical assessment was completed by either a glaucoma consultant or fellow. Proformas were reviewed remotely by one of two additional glaucoma consultants, and 12 months later, by the clinicians who had undertaken the original clinical examination. The interobserver and intraobserver decision-making agreements of virtual assessment versus standard care were calculated.
  
  
  
  We identified adverse disagreement between face-to-face and virtual review in 7/204 (3.4%, 95% CI 0.9% to 5.9%) patients, where virtual review failed to predict a need to accelerated follow-up identified in face-to-face review. Misclassification events were rare, occurring in 1.9% (95% CI 0.3% to 3.8%) of assessments. Interobserver κ (95% CI) showed only fair agreement (0.24 (0.04 to 0.43)); this improved to moderate agreement when only consultant decisions were compared against each other (κ=0.41 (0.16 to 0.65)). The intraobserver agreement κ (95% CI) for the consultant was 0.274 (0.073 to 0.476), and that for the fellow was 0.264 (0.031 to 0.497).
  
  
  
  The low rate of adverse misclassification, combined with the slowly progressive nature of most glaucoma, and the fact that patients will all be regularly reassessed, suggests that virtual clinics offer a safe, logistically viable option for selected patients with glaucoma.
authors.affiliation: Glaucoma Service, Moorfields Eye Hospital London, London, UK.|NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Clarke
authors.affiliation: Glaucoma Service, Moorfields Eye Hospital London, London, UK.
authors.forename: Renata
authors.initials: R
authors.lastname: Puertas
authors.affiliation: Glaucoma Service, Moorfields Eye Hospital London, London, UK.|NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
authors.forename: Aachal
authors.initials: A
authors.lastname: Kotecha
authors.affiliation: Glaucoma Service, Moorfields Eye Hospital London, London, UK.|NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Foster
authors.affiliation: Glaucoma Service, Moorfields Eye Hospital London, London, UK.|NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Barton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000379:methods*; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D011446:Prospective Studies; D012372:ROC Curve; D012017:Referral and Consultation; D013997:Time Factors
keywords: Diagnostic tests/Investigation; Glaucoma; Telemedicine