Development and evaluation of teleglaucoma programme in a teaching hospital in Kuala Lumpur for the prevention of future blindness in Malaysia

Abstract

Glaucoma, a leading cause of irreversible blindness, necessitates timely diagnosis as disease is asymptomatic. Undetected glaucoma remains a challenging issue even in developed countries, revealing limitations in current case detection. Significant economic and productivity losses due to blindness caused by glaucoma demand a better detection of glaucoma cases. Teleglaucoma, a telemedicine for glaucoma, offers a promising solution to overcome these challenges. The aim of this study was to explore the role of a teleglaucoma programme in improving the detection rate of cases with glaucoma and probable glaucoma in the Malaysian population. This study comprised of five study phases which were (1) identify strategies for implementation of teleglaucoma programme and (2) components of its training programme using systematic reviews and qualitative interviews, (3) development, validation and evaluation of training programme for glaucoma screeners, (4) usability and functionality of a local teleglaucoma system and (5) comparison of detection rate of glaucoma or probable glaucoma between teleglaucoma pathway at Primer Clinic and opportunistic case finding pathway at Sentul Health Clinic. Components for implementation of teleglaucoma programme include high-risk individuals of glaucoma, glaucoma screening examinations including history taking, visual acuity test, tonometry, fundus photography and perimetry, accessible screening locations, well- connected teleglaucoma system, skilled personnel, and a clear referral guideline. The training module were developed in Malay and English languages with good content and face validity by both experts and targeted participants. The training module increased the glaucoma screeners' knowledge (p=0.02) and skills (100% pass) in glaucoma screening. The local teleglaucoma system was found to be user-friendly and functionable. The detection rate of glaucoma and probable glaucoma using teleglaucoma sys (6%) was higher compared to the opportunistic case finding (1.4%). This study is the first in Malaysia that explored the feasibility of implementing a teleglaucoma screening programme using a local system. Teleglaucoma programme can transform the standard glaucoma practice, leading to early identification and prevent blindness. Future study should include evaluation of cost-effectiveness in implementation of teleglaucoma in Malaysia.