Primary care optometry-based diabetic retinopathy review clinics - a new model of care and comparison with virtual diabetic retinopathy clinics

Background: Given the increasing prevalence of diabetes and diabetic retinopathy (DR) in the UK, this study evaluates a novel primary care optometry-based DR review service against traditional hospital-based virtual DR clinics.

Methods: In the hospital-based virtual DR service, patients attended for data capture (visual acuity, fundus photography, macular OCT scanning) with asynchronous review at a later data by a hospital clinician. In the primary care optometry DR review clinic, patients attended an optometry practice for a face-to-face(F2F) review (with imaging) by an optometrist with additional training in DR. Data from both clinic types were analysed. Metrics included DR grading, management plans, grading concordance between primary care optometrists and consultant ophthalmologists, and the assessment of "ungradable" retinopathy referrals.

Results: One thousand seven hundred and sixty patients attended the virtual clinic between January 2021 and September 2023. 954 patients attended the primary care review clinic between August 2022 and September 2023. Grading agreements between primary care optometrists and hospital consultants on those patients referred for consultant opinion were significant with Weighted Kappa scores of 0.61(95% CI 0.52-0.69) for DR grade and 0.69(95% CI 0.56-0.82) for diabetic macular oedema (DMO) status. Additionally, the primary care optometry clinic reported a considerably reduced non-attendance rate of 5%, in contrast to 21% in virtual clinics.

Conclusion: The primary care optometry-based DR service emerges as an efficient, safe alternative to hospital services. It offers notable advantages over virtual clinics and addresses a care gap for those unsuitable for virtual consultations. The results highlight the potential of primary care-based models in managing DR.