Royal Victoria Infirmary utilises diagnostic hubs to provide greater access to sight-saving care

Richard Bell, Senior Medical Photographer, The Royal Victoria Infirmary with the ANTERION.

The Royal Victoria Infirmary (RVI) in Newcastle upon Tyne, UK, is utilising a diagnostic hub model to offer more people with sight threatening conditions timely treatment, when pressures on services due to the pandemic have caused inevitable delays. The first hub opened in March 2021 as a glaucoma clinic and is soon to be followed by a medical retina clinic next door.

“We didn’t see as many patients as normal during the COVID-19 pandemic due to staggering appointment times to maintain social distancing in clinic,” explains Richard Bell, Senior Medical Photographer at The Royal Victoria Infirmary. “One of our consultant ophthalmologists, Mr. James Talks, had read about the successful diagnostic hub model at Moorfields Eye Hospital and suggested we do something similar.” The project was approved, and the glaucoma diagnostic hub was set-up first. “A large room became available above the existing eye clinic, suited perfectly for our glaucoma hub as it provides ample space for equipment and social distancing,” says Richard.

Patients at the glaucoma hub undergo a variety of specialised tests that include visual fields, tonometry, and OCT. The results are reviewed by the nurse practitioners, who check for “red flags” which would indicate that immediate further investigation or urgent treatment is required, and then virtually by the ophthalmologists. The patient receives a letter in 2-3 weeks with the outcome. “This model is extremely efficient and has been facilitating faster access to appointments and treatment for patients. Due to the increase in capacity, there is little waiting involved in the day, which is great for patients,” explains Richard.

The “gold standard” in imaging

Diagnostic functionality, ease of use, and image quality were important considerations when choosing the imaging equipment for the glaucoma hub. OCT imaging of the optic nerve head, ganglion cell layer, and anterior chamber angles is a cornerstone in the diagnostic tests.

Glaucoma diagnostic hub at The Royal Victoria Infirmary (ANTERION and SPECTRALIS instruments)
“The OCT is easy to use and allows a high degree of flexibility in imaging. The manual focus and joystick controls are very useful in an NHS clinic as we are seeing patients that can be traditionally challenging to image. The OCT really makes the difference in this regard and allows us to capture images, even in patients with nystagmus or high myopia”. The confocal scanning laser technology employed by the OCT offers specific benefits in a hub model. “We don’t dilate the eyes of patients who attend the glaucoma hub, which is no problem for the OCT. This speeds up the workflow and encourages more patients to attend their appointment as they are able to drive”.

Imaging the anterior chamber using swept-source OCT technology is a welcome addition to the team at RVI. “The anterior OCT is intuitive and easy to use. We use it to look at the chamber angles and the image quality is incredible. We will shortly upgrade our software, which will connect the anterior and posterior OCT devices into one image management software platform. The new software will also enable us to scale up our data storage space easily and push out software upgrades across all devices and viewing stations, which is important for a huge imaging department like ours,” explains Richard. The team will shortly take delivery of an OCT for the new medical retina hub, too. Richard elaborates: “Whilst the OCT in the glaucoma hub was configured with premium glaucoma imaging, the OCT in the MR hub will have MultiColor, BluePeak autofluorescence, and OCT angiography imaging capabilities. It’s great how the OCT is multimodal and can be configured to the specific workflow of the clinic.”