Remote and Sustainable Eye Care: Validation & Valorization

Abstract

Chapter 2 describes a systematic review that determined the variability associated with visual acuity (VA) and refractive error (RE). We provided an update, underlining that the current variability is much more variable than previously suggested in the literature. With this in mind, we assessed the self-administered online eye test which uses a phone, a computer, and three meters of distance. Participants used the phone as a remote control to identify optotypes presented on the computer screen. In Chapter 3 we analyzed this online eye test in a large, real-world healthy dataset. We learned that the algorithm underestimates hyperopes, reporting higher variability compared to myopes and that self-administered home testing is feasible in a heterogenous population. In Chapter 4 we compared the online eye test with the golden standard in patients with macular diseases. In this study we learned that the agreement of the web-based VA test is on par with Snellen line assessment, yet subpar to the ETDRS chart. Moreover, we showed that elderly still can perform this test independently at home. In Chapter 5 we describe a subsequent qualitative stakeholder analysis defining barriers and opportunities in a screening perspective. This taught us that also children and parents were open to self-administered eye testing as a screening method. Eye care professionals and costs and scientific reliability. For better implementation, policymakers underlined the relevance of meeting the framework of screening criteria. In Chapter 6, a costing study of the clinical CORE trial is described. The CORE trial is a multinational-RCT which assessed the clinical outcomes of VA and RE in postoperative cataract follow-up. It taught us that the costs of missed complications due to telemedicine are heavily outweighed by the cost-savings, driven by societal savings of informal care and productivity. Therefore, there is a high change of cost-savings by replacing the physical follow-up with remote follow-up. In Chapter 7 we examined remote eyecare in practice. Patients were remotely prioritized based on clinical urgency and severity via the TeleTriageTeam (TTT). The potential impact of delaying less urgent patients and expediting more urgent ones was assessed through expert interviews, and combining clinical outcomes with literature data. This taught us that judicious prioritizing patients was expected to lead to overall gains in quality of life and societal cost savings. It also taught us that delay of care results in reduced quality of live and increased societal costs in those not prioritized and that prioritizing should be based on individual symptoms instead of general diagnoses. Chapter 8 debates the role of telemedicine in sustainable health care. We learned that travelling to and from the clinic was the most significant contributor to carbon emissions. Also, relevant factors were structurally not reported, and that the reporting of data, quality, and transparency was low. Saved emissions by telemedicine were structurally nderestimated, hindering the adoption of sustainable policies. Just as telemedicine, sustainability is a quickly evolving field in clinical research. Therefore, Chapter 9 assesses the sustainability and environmental impact of disposables, reusables, and recycling stainless- steel instruments used during cataract surgery. We learned that reusable instrument can be used for 3.500-4.000 surgeries before being sent to waste management. Short-term impact can easily be made, such as by averting single-use instruments, and by reducing just-in-time-logistics making flight travel of these instruments more redundant.