Assessing the Effectiveness of an Optometrist-Led Asynchronous Virtual Ophthalmology Service for Stable Eye Conditions Within the Singapore Eye Care Landscape

PURPOSE: The Virtual Ophthalmology Service (TVOS) is an optometrist-led virtual ophthalmology service designed to reduce physical consultations for patients with stable eye conditions. However, evidence on care quality, efficiency, and patient feedback remains limited. The aim of this study was to evaluate the effectiveness, efficiency, and patient acceptability of an optometrist-led asynchronous TVOS through a real-world service evaluation. METHODS: TVOS case notes between 2020 and 2023 were retrospectively extracted. Care quality was assessed using concordance of the overall management plan and Cohen's kappa of management plan components. Discordance was defined as a disagreement between optometrists and ophthalmologists in the management plan (e.g. follow-up location or duration). Turnaround time (TAT) and patient satisfaction were analysed using separate audit data. TAT, the total duration of a patient's clinic visit, was measured from the time of registration to the time of payment, and patient satisfaction was assessed through a structured satisfaction questionnaire. RESULTS: A total of 2629 records were included in the final analysis. High overall concordance (91.4%) for the management plan, with strong agreement (Cohen's kappa: 0.87-0.94) on the management components, was observed. Among discordant cases, optometrists recommended a shorter follow-up duration than ophthalmologists in 75.4% of cases and a higher level of care for follow-up location in 44.4% of cases. The median waiting time was 24.6 min, and the median TAT was 36.6 min. Overall, 88.6% of the respondents were satisfied with the TVOS service, and 95.7% were satisfied with its efficiency. CONCLUSION: TVOS provided high-quality care with high patient satisfaction. These findings support TVOS as a feasible and safe model for improving efficiency and access to eye care.