[Feedback on ophthalmologic telemedicine in a nursing home]. / La télé-ophtalmologie en EHPAD : retour d'expérience.

INTRODUCTION: Ophthalmologic care needings increase whereas the numbers of ophthalmologist decrease. Oldest people who are often vulnerable and dependent populations are particularly affected in difficulty to access to health services. To resolve the problem, the use of telemedicine in ophthalmology could be an alternative. MATERIALS AND METHODS: From June 2018 to November 2018, patients from Janzé Hospital (Ille et Vilaine) did an ophthalmologic teleconsultation during their stay. Teleconsultation was based on visual acuity, intraocular pressure measurement, wild-field retinophotography and optical coherence tomography performed by an orthoptist and a videoconference with an ophthalmologist. RESULTS: Sixty-seven patients underwent teleconsultation (60 % women, 40 % men). Mean age was 83 (standard deviation±8). Fifty-four percent (36) of consultations were complete. Retinophotography was missing in 45 % of cases (30) and optical coherence tomography in 53 % of cases (35). Ophtalmologic pathologies were detected in 37 patients (55 %) and we start medical care in 14 (38 %) of the patients. We gave glasses prescription to 45 % (30) of the patients. Eighteen percent (10) of the patients required a physical consultation. LogMar distance visual acuity was significantly improved from 0.67 (±0.76) to 0.52 (±0.72) (P<0.0001) and LogMar near visual acuity was significantly improved from 0.68 (±0.84) to 0.53 (±0.76) (P<0.0001). Low vision proportion was significantly decreased from 54 % to 39 % (P=0.02; OR=1.86; IC95 % [1.06-3.28]) after our intervention. DISCUSSION: This experiment gives the opportunity to old, vulnerable and dependent population that has no longer access to classical consultation to access eye care. At the same time, consultation informs the nursing home caregivers about the visual health status and provides environment improvement. CONCLUSION: Teleconsultation is an alternative to classical consultation especially in dependent population. This experiment could be a starting point to the development of this solution in social health-care institutions.

Feedback on ophthalmologic telemedicine in a nursing home.

INTRODUCTION: The need for ophthalmologist appointments is increasing, while the number of practitioners is decreasing. Elderly patients, who may be dependent and isolated, are the most affected by this barrier to care. In order to get around this obstacle, telemedicine visits might be an alternative. MATERIALS AND METHODS: From June 2018 to November 2018, patients in the housing facility for dependent elderly individuals (EHPAD) at the Janzé (Ille-et-Vilaine) Medical Centre participated in an ophthalmology telemedicine visit during their stay. The telemedicine visit included measurement of visual acuity, intraocular pressure, wide field fundus photography, and optical coherence tomography (OCT) performed by a technician, and a videoconference with an ophthalmologist. RESULTS: Sixty-seven patients aged 83±8 years (60% women and 40% men) underwent a telemedicine visit. The visit was completed in 36 (54%) cases. The fundus photography was not performed in 30 (45%) cases, and the OCT was not performed in 35 (53%) cases. We diagnosed an ophthalmologic disease in 37 (55%) patients, with medical management having begun in 14 (38%) of them. A prescription for corrective lenses was given in 30 patients (45%). Following our visit, mean logMar visual acuity experienced a statistically significant improvement from 0.67 (±0.76) to 0.52 (±0.72) (P<0.0001) for distance vision and from 0.68 (±0.84) to 0.53 (±0.76) (P<0.0001) for near vision. Eighteen per cent of patients (10) required transportation to an in-person ophthalmologist visit for continued management. With regard to low vision, the proportion of low-vision eyes experienced a statistically significant decrease from 54% to 39% [P=0.02; OR=1.86; 95% CI (1.06-3.28)] following our visit. DISCUSSION: This experiment allowed an isolated, dependent patient population without access to classic office visits to gain access to clinical care. In addition to providing eye care to the patients, the visit increased awareness amongst the caregivers of the vision status of the residents, allowing them to adapt their environment accordingly. CONCLUSION: Telemedicine is an alternative to classic physician visits, particularly for very dependent, institutionalised patients. This experiment might serve as a point of departure for generalised adoption of these solutions within extended care facilities.