Background

The KSYOS TeleMedical Centre has been performing TeleFundusScreenings throughout the Netherlands since 2008, working with ophthalmologists, optometrists, general practitioners, healthcare groups, medical diagnostic centres and hospitals. KSYOS performed just over 30,000 TeleFundusScreenings in 2012. A deviating fundus screening is presented to local ophthalmologists by means of a TeleOphthalmology Consult. This prevents over half of the (unnecessary) referrals to the hospital.
Patients are often referred to the ophthalmologist for eye disorders such as retinopathy, cataracts, macular degeneration and glaucoma. Market parties are pushing for a shift from secondary to primary care. Optometrists have been performing fundus screenings for patients with diabetes mellitus (DM) for years [Healthcare standard DRP screening 2006, NOG]. This allows many DM patients to be taken care of in primary care. It may be possible for optometrists to take over other ophthalmological diagnostics and screening, under the supervision of the ophthalmologist. KSYOS is researching this in a pilot with optometrists, general practitioners and ophthalmologists

The pilot

The pilot wants to answer the following research question: ‘What is the inter-rater reliability of the optometric diagnosis and advice between optometrists and ophthalmologists when assessing retinopathy, cataracts, macular degeneration or glaucoma?’

Process

The optometrist performs the eye examination at his own indication or after referral by the general practitioner. The eye examination includes medical history, (stenopeic) vision, refraction, fundus photographs and tonometry. If necessary, a slit-lamp exam may also be carried out. For glaucoma, gonioscopy, pachymetry and visual field examinations are added or a determination of the thickness of the ocular nerve tissue is made using GDx or OCT. The data are entered in the KSYOS system by the optometrist. We call this the “TeleOphthalmology Examination”. All TeleOphthalmology Examinations are checked by ophthalmologists via a TeleOphthalmology Consult. The general practitioner receives the results in the GP Information System, along with the findings, diagnosis and advice of the optometrist and ophthalmologist.