Results from the First Teleglaucoma Pilot Project in Addis Ababa, Ethiopia.

PRECIS: A teleglaucoma case finding model was employed in Ethiopia using a higher-risk case identification approach. 7.9% of patients had definite glaucoma. 13.8% were glaucoma suspects. Most cases could be managed medically.

BACKGROUND: To analyze disease prevalence and clinical referral pathways of high-risk patients assessed through a hospital-based teleglaucoma case finding program.

METHODS: Patients over age 35 were referred from outpatient diabetic & hypertensive clinics. Through a teleglaucoma consultation, a glaucoma specialist provided remote diagnosis & management recommendations. Patient referral pathways were analyzed. Part way through the program frontline ophthalmic nurses and optometrists were empowered to refer patients to be seen by general ophthalmologists within a week if patients met high-risk criteria. Qualitative stakeholder feedback was also obtained.

RESULTS: 1002 patients (53% female) were assessed with a mean age of 51.0±11.7 years. The prevalence of glaucoma and glaucoma suspects were 7.9% (79 cases) and 13.8% (138 cases) respectively. Retinopathy was found in 9.1% with hypertensive retinopathy (2.7%) and diabetic retinopathy (2.5%) representing the majority. Age-related macular degeneration was present in 1.5% and cataract in 16%. 63% of cases were without organic eye disease. 35% of patients were referred to a general ophthalmologist, 0.7% to a glaucoma specialist (for surgery), 1.5% to a retina specialist and 17.7% to an optometrist for further care. Qualitative analysis revealed that stakeholders felt the value of teleglaucoma would be in triaging patients requiring more urgent management and identify disease at an earlier stage.

CONCLUSION: There is a high prevalence of glaucoma in Ethiopian patients assessed through this teleglaucoma program. This model and study have also demonstrated various principles behind telemedicine such as development of an intelligent triage system, case-finding for a variety of diseases, and consideration of optimal patient flow/referral pathways.