Introduction
Telemedicine is the use of electronic information and communication technologies to deliver healthcare services at a distance1 and is well established in ophthalmology, particularly in the subspecialty areas of medical retina and glaucoma.2–5 Prior to the COVID-19 pandemic, the reported applications of telemedicine in oculoplastics were largely limited to settings where the access to healthcare remains a challenge6–9 and only few studies evaluated the utility of synchronous telemedicine in assessment of oculoplastic conditions.10–12 Since the emergence of COVID-19, the use of telemedicine, particularly video consultations, has increased exponentially. The literature reports varying degree of effectiveness of video consultations in assessment of eyelid lesions.13 14 While the evidence base for the use of video consultations in oculoplastics is growing following the COVID-19 outbreak, the literature on the application of asynchronous or store-and-forward telemedicine in the assessment of eyelid lesions remains scarce.15 16 This contrasts significantly with the successful implementation and scaling of a closely related specialty—teledermatology, which has matured over two decades and is now a widely accepted form of service delivery.17
The hospital eye service is experiencing a severe shortage of resources to safely cope with demand and it is predicted that the demand will increase by 30%–40% over the next 20 years.18 In our oculoplastic service patients with eyelid lesions make up more than 50% of new referrals. Optimising pathways for these patients is vital to provide an efficient service and to reduce waiting times particularly when identification of malignant lesions is time sensitive. Multiple initiatives have been implemented to offer prompt diagnosis and treatment of eyelid lesions. A nurse-led eyelid lesions service has been shown to provide comparable diagnostic accuracy compared with a doctor-led service.19 One-stop minor surgery lists have been set up in order to provide patients with same day surgery to expedite the delivery of their treatment and to reduce the need for multiple hospital visits. The National Health Service (NHS) long-term plan and NHS England service transformation plans for ophthalmology suggest remote care as a means to cope with a surge in patient demand.20 21 The recent pandemic along with the increasing access and use of the internet and digital technology as well as growing acceptance of remote care among clinicians and patients have accelerated the move towards telemedicine.
We investigated the use of asynchronous telemedicine to remotely diagnose and formulate management plans for eyelid lesions. To enhance the diagnostic accuracy of such an approach, templates for structured and pertinent data collection including patient history, along with photographs of eyelid lesions were designed and used. The data and photographs were reviewed by a clinician in the absence of the patient. The agreement between the diagnosis and management plan reached by clinician reviewing the data remotely with those devised by clinician reviewing patients in face-to-face clinics was assessed.