Remote tele-ophthalmology: advice and guidance for urgent eye conditions using Android (adults)

NHS Grampian’s Eye Health Network is a managed network involving more than 150 optometrists from 58 community optometry practices. It works alongside the hospital eye service at Aberdeen Royal Infirmary and Dr Gray’s Hospital, Elgin.

Situation

Within the NHS, the general practitioner (GP) has traditionally been the first point of contact for most patients with an eye problem. However, GPs often do not have the necessary equipment, or see a large enough volume of eye emergencies, to effectively diagnose and treat more complex acute eye conditions.

This means there are avoidable attendances where these patients go to hospital eye departments for ophthalmologists to diagnose and manage minor eye conditions. This led to increased demands on an already strained hospital eye service and recognition that many acute eye patients attending hospital could be managed in the community by primary care optometrists.

Aspiration

NHS Grampian wanted to redesign its eye health service to better meet the needs of its population and improve patient access for acute eye care. It specifically wanted to work more closely with primary care optometrists and to create strong links with secondary care for advice and guidance.

Solution and impact

The applications (apps) and website for NHS Grampian’s Eye Health Network clinical guidelines were developed in 2016 as part of the National Ophthalmology Workstream. The aim of the website and apps was to improve standardisation, accessibility, usability and currency of primary care optometry clinical guidelines and pathways, which are adapted from national guidance from the College of Optometrists and agreed by all local eye care stakeholders.

These support more management in primary care as well as better referral and advice and guidance for shared care. These can be easily accessed by primary and secondary care on computers, smartphones and tablet devices. As part of this guidance they currently incorporate the use of Peek Acuity for home visual acuity testing. Visual acuity is a key clinical test required to assess any eye care patient and the ability to measure remotely supports remote care and the ability of the patient to self-monitor their eye condition.

Functionality

Peek Acuity Pro is a smartphone-based app for checking vision and provides an easy-to-understand visual representation of results.

Capabilities

  • Measures vision (visual acuity)
  • Proven to be as accurate as conventional vision tests in peer-reviewed research
  • Works on Android devices
  • Fast and easy to use with a step-by-step tutorial
  • Accurate and repeatable results
  • Creates a visual representation of results for explanation to patients
  • Includes simulated representation that helps explain results to patients
  • Scores are provided in standard units of Snellen (including metric 6/6, imperial 20/20) and LogMAR (0.0)
  • Includes equivalents of ‘count fingers’, ‘hand movements’ and ‘light perception’
  • Does not collect any personally-identifiable data

Scope

  • To measure vision accurately at home, remotely at a GP practice, on a ward or in A&E
  • For remote consultations or home monitoring

Key figures/quotes 

The Peek Acuity app was validated against Snellen charts and a clinic measurement using the ETDRS chart.

Find out more

Read the online community eye care guidance for COVID-19 here

You can download the NHS Grampian EHN service report here