Integration of Remote Care in the Future of Glaucoma Management

Educational Objectives

The goal of this program is to improve remote glaucoma care. After hearing and assimilating this program, the clinician will be better able to:

1. Justify the integration of remote care in glaucoma management.

Summary

Remote monitoring: requires patient involvement, is economical, and improves care; challenges in glaucoma care include the need for frequent monitoring and assessment, access to care (may require long-distance travel), and compliance, especially in children and elderly persons

Remote care: more convenient; increases compliance; helps the physician relate to the child and the family; avoids the need for long-distance travel; new tools allow assessment at home by parents and better data collection

Technology: helps increase compliance and relatability; new applications offer timely medication reminders and enable testing (eg, visual field assessment); the data can be stored in the cloud, which allows the patient and the physician to be alerted to abnormal results; an application developed by an ophthalmologist allows eye testing and rapid communication

New tools: allow for remote monitoring; glaucoma care is dependent on test results and data for decision-making; home intraocular pressure (IOP) monitoring — devices incorporating cloud-based data storage (eg, Icare HOME) are available; empowers patients in glaucoma management; transmits real-time data and enables rapid alterations in prescriptions; frequent monitoring can identify IOP fluctuations early and avoid vision loss; fundus imaging — smartphone-based screening using fundus photographs can provide images to ophthalmologists directly and can be incorporated into electronic medical records (EMR); remote assessment of retinal nerve fiber layer thickness is difficult; home visual field monitoring — several head-mounted devices are available; important in follow-up of younger patients; allows repeated measurements at home

Glaucoma screening: remote screening has enabled early diagnosis in adults and children; children from other countries have late diagnosis of pediatric glaucoma; the Pediatric Preventable Blindness (PPB) initiative helps identify potential visual impairment and eradicate vision loss; medical personnel are not needed for administering the tests; the PPB initiative is successful, with high referral rates; the model can be expanded to other areas; the tools for children are different from tools that are available for adults; cloud-based models are appropriate for places with low resources and inadequate medical personnel; remote screening can help document the pupillary reflex in EMR; vision screening devices can provide alignment and refraction data; when incorporated into vaccination programs, vision screening adds only 4 min to vaccinations

Artificial intelligence (AI): data analysis using AI can help make accurate and early diagnoses; AI algorithms can predict prognosis and identify patients requiring intensive care

Remote monitoring vs traditional visits: Clarke et al (2017) found that remote monitoring is a safe and viable option; remote monitoring can provide a robust dataset for AI analysis

Benefits: remote care provides specialized eye care in geographically remote areas; cloud-based data-sharing allows specialists around the world to remotely review the results; the PPB initiative can be expanded to other regions; the speaker exhorts ophthalmologists to embrace new technologies to improve patient care

Take-home points: collaboration of science and the art of medicine is essential for advancing health care and is an indispensable duty

Readings

Che Hamzah J, Daka Q, Azuara-Blanco A. Home monitoring for glaucoma. Eye (Lond). 2020;34(1):155-160. doi:10.1038/s41433-019-0669-7; Clarke J, Puertas R, Kotecha A, et al. Virtual clinics in glaucoma care: face-to-face versus remote decision-making. Br J Ophthalmol. 2017;101(7):892-895. doi:10.1136/bjophthalmol-2016-308993; McLaughlin DE, Savatovsky EJ, O’Brien RC, et al. Reliability of visual field testing in a telehealth setting using a head-mounted device: a pilot study. J Glaucoma. 2024;33(1):15-23. doi:10.1097/IJG.0000000000002290.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Grajewski was recorded at XLVI Inter-American Course in Clinical Ophthalmology (CURSO), held October 27-30, 2024, in Miami, FL, and presented by Bascom Palmer Eye Institute, University of Miami Health System. For more information about upcoming CME activities from this presenter, please visit https://umiamihealth.org/bascom-palmer-eye-institute/healthcare-professionals/continuing-medical-education. Audio Digest thanks the speakers and Bascom Palmer Eye Institute for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.75 CE contact hours.

Lecture ID:

OP630802

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.