Feedback on ophthalmologic telemedicine in a nursing home

Introduction. - Ophthalmologic care needings increase whereas the numbers of ophthalmologist decrease. Oldest people who are often vulnerable and dependent populations are particularly affected in difficulty to access to health services. To resolve the problem, the use of telemedicine in ophthalmology could be an alternative. Materials and methods. - From June 2018 to November 2018, patients from Janze Hospital (Ille et Vilaine) did an ophthalmologic teleconsultation during their stay. Teleconsultation was based on visual acuity, intraocular pressure measurement, wild-field retinophotography and optical coherence tomography performed by an orthoptist and a videoconference with an ophthalmologist. Results. - Sixty-seven patients underwent teleconsultation (60 % women, 40 % men). Mean age was 83 (standard deviation +/- 8). Fifty-four percent (36) of consultations were complete. Retinophotography was missing in 45 % of cases (30) and optical coherence tomography in 53 % of cases (35). Ophtalmologic pathologies were detected in 37 patients (55 %) and we start medical care in 14 (38 %) of the patients. We gave glasses prescription to 45 % (30) of the patients. Eighteen percent (10) of the patients required a physical consultation. LogMar distance visual acuity was significantly improved from 0.67 (+/- 0.76) to 0.52 (+/- 0.72) (P < 0.0001) and LogMar near visual acuity was significantly improved from 0.68 (+/- 0.84) to 0.53 (+/- 0.76) (P < 0.0001). Low vision proportion was significantly decreased from 54 % to 39 % (P = 0.02; OR = 1.86; IC95 % [1.06-3.28]) after our intervention. Discussion. - This experiment gives the opportunity to old, vulnerable and dependent population that has no longer access to classical consultation to access eye care. At the same time, consultation informs the nursing home caregivers about the visual health status and provides environment improvement. Conclusion. -Teleconsultation is an alternative to classical consultation especially in dependent population. This experiment could be a starting point to the development of this solution in social health-care institutions. (C) 2020 Published by Elsevier Masson SAS.