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Remote triage of microbial keratitis – a surprising silver lining of the COVID-19 pandemic or a temporary necessity that should be consigned to the theoretical waste bin?

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First Author: N.Mirza UK

Co Author(s):    T. Khanam                    

Abstract Details

Purpose:

An acute red eye is the most common presentation to Ophthalmology services, the underlying diagnostic possibilities of which are vast. A focused history and objective examination allow rapid diagnosis in most instances. The resultant restrictions of the COVID-19 pandemic meant objective examinations were no longer routinely possible and staff were abruptly made to rely on telephone consultations alone in the vast majority of cases. We aim to assess the effectiveness of remote triage in the diagnosis and treatment of presumed microbial keratitis.

Setting:

The study was conducted at the Hull and East Yorkshire Eye Hospital, a tertiary centre for Ophthalmic services in the UK, catering to a population of approximately 600,000.

Methods:

The retrospective study included patients who underwent their initial consultation either by phone or in person between March 20th and May 31st 2020. This time period reflects when strict measures were in place regarding reviewing patients within our department. Data was obtained from a custom spreadsheet utilised during the pandemic service and Medisoft electronic patient record software.

Results:

Over a 10 week period 44 patients were treated for presumed or confirmed microbial keratitis, generating 156 consultations in total. 61% of patients were initially triaged and managed remotely, a third of which were invited for face to face evaluation due to diagnostic uncertainty or unsatisfactory progress. Contact lens wear and a history of herpetic disease were common factors in patients requiring face to face review after being initially remotely managed. 70% of patients initially seen in the department required 3 or more consults compared to 66% of initially remotely managed patients.

Conclusions:

The unprecedented circumstances secondary to the COVID-19 pandemic gave rise to innovative practices in Ophthalmology units across the globe. We have found that in a significant number of cases we were able to safely triage and manage presumed microbial keratitis remotely. We feel this work contributes evidence that remote triage has a role to play in acute Ophthalmic services.

Financial Disclosure:

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