Systematic review of current tele-ophthalmology services in New Zealand compared to the four comparable countries of the United Kingdom, Australia, United States of America and Canada

ABSTRACT

Background: Over 700,000 New Zealanders (NZ), particularly elderly and Māori, live without timely access to specialist ophthalmology services. Teleophthalmology is a widely recognised tool assisting in overcoming resource and distance barriers. The aim was to conduct a systematic review identifying, describing and contrasting teleophthalmology services in NZ with the comparable countries of Australia, USA, Canada and the United Kingdom, also assessing any changes to programs pre- and post-COVID-19 pandemic. Method: The electronic databases Embase, Pubmed, Web of Science, Google Scholar and Google were systemically searched in August 2020, filtered to the countries above, then again in June 2021 to gather COVID-19 pandemic teleophthalmology literature. Results: A total of 128 studies were identified describing 108 discrete teleophthalmology services. Articles spanned from 1997-2021. Models were categorised into general eye care (n = 16;14.8%) emergency/trauma (n = 6;5.5%) school screening (n = 13;12%), artificial intelligence (n = 19;17.5%) and disease specific models of care (n = 54;50%). The most common diseases addressed were diabetic retinopathy (n = 22;20.3%), retinopathy of prematurity (n = 12;11%) and glaucoma (n = 9;8.3%). Typically models involved local clinicians transmitting images or video, usually fed-forward. The second search yielded 14 COVID-19-based teleophthalmology services, involving significantly increased home monitoring, telephone/video live-consults. Conclusion: Teleophthalmology will play a crucial role in the future of eye care. COVID-19 offers a unique opportunity for improvement and expansion of teleophthalmology. Feed-forward and increasingly, live-based teleophthalmology services have demonstrated feasibility and cost-effectiveness in similar countries internationally. New Zealand's should invest in strategic partnerships and technology nationally to improve eye health equity.