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Editors Selection IGR 15-4

Miscellaneous: Assessing 3 years of a virtual glaucoma clinic

Comment by Chris Leung on:

109983 Three-year Outcomes of an Expanded Asynchronous Virtual Glaucoma Clinic in Singapore, Lee YF; Chay J; Husain R et al., Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2023; 12: 364-369

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Virtual glaucoma clinics have experienced a surge in popularity since the outbreak of COVID-19. The authors of this study developed and evaluated the Glaucoma Observation Clinic (GLOC) that focused on stable glaucoma patients who did not require frequent face-to-face consultations. Building upon their previous work,1 they expanded its scope to include a wider range of glaucoma phenotypes and disease stages, and assessed the safety, time efficiency, and cost-savings of this approach.

The authors found that GLOC offered a more efficient and convenient experience for patients, as they could avoid long waiting times at clinics and pharmacies. They also estimated the costs of GLOC and compared them to a conventional clinic, using a Markov model that simulated the lifetime outcomes. The model considered the risk of disease progression and mortality, and the transition of patients between GLOC and conventional clinic based on their stability. The study showed that GLOC could save $28.85 per patient per visit in manpower costs, and $280.65 per patient over their lifetime, compared to a conventional clinic.

One issue was the exclusion of the manpower costs associated with ophthalmic investigations in GLOC, which could significantly underestimate the cost of GLOC and overestimate its savings

However, the study also had some limitations and uncertainties that need to be addressed in future research. One issue was the exclusion of the manpower costs associated with ophthalmic investigations in GLOC, which could significantly underestimate the cost of GLOC and overestimate its savings (the authors justified this exclusion by stating that the same manpower was also used to provide clinical services to other ophthalmology subspecialties). Another issue was the lack of clarity on how visual field progression and progressive retinal nerve fiber layer thinning were determined. Reliable detection of glaucoma progression is key to ensure patient safety. It was unclear whether the number of follow-up visits and tests was sufficient to detect glaucoma progression reliably. Assessment of VF progression, for example, would typically require four to five VF tests.

Another issue was the lack of clarity on how visual field progression and progressive retinal nerve fiber layer thinning were determined

While GLOC potentially offers cost savings, there is a need for additional studies to investigate patient outcomes and satisfaction, and establish whether GLOC is effective in monitoring glaucoma, ensuring patient adherence to treatment, and preserving the quality of life.

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