*5.10. Productivity*

The waiting list for new glaucoma/OHT suspect referrals to the GE decreased; most of the follow-up appointments of stable, low risk glaucoma suspects/patients were given to the non-medical staff, thereby saving the GE time [36,41]. Also, the non-medical staff could ensure these patients got their appointments on time.

The access of complex patients and unstable patients to the GE increased [34]. The non-medical staff was made responsible for monitoring stable glaucoma, thereby saving time for the GE to accept more complex patients and to see all patients on time and detect progression quickly. Holtzer-Goor et al. found a significantly lower VA in the StC-GFU; this could indicate that more complex patients were directed to the StC-GFU, thereby achieving one of the main goals of SC [36]. Likewise, the number of procedures performed by the GE tended to increase when cooperating with the non-medical staff in the SC-MC suggesting better access of complex patients to care provided by the GE [34].

By delegating triaging, GEs were also less busy with the initial assessment. The GAC and the GSC respectively sent only 79.5% and 32.0% to the GE for a face-to-face assessment [48,49]. The GSC sent less people to the StC outpatient clinic because they could refer stable OHT/glaucoma suspects/glaucoma patients with low-to-moderate risk to the SMS [49,56,57].

#### *5.11. Directions for Future Research*

Since hospitals do not always employ all non-medical staff professions, the effect of replacing one profession by another should be studied. Furthermore, the impact of VCs on compliance to guidelines/protocol should be investigated. Decisions made through virtual review were not completely similar to those made through face-to-face assessment, which could be caused by not assessing the patient face-to-face, or by the non-medical staff not providing accurate data. A deeper analysis is needed to improve our knowledge regarding these findings. An economic analysis of SC/VCs versus StC, the long-term effect of SC/VCs on the disease itself and possible synergetic effects when combining SC and VCs are other interesting topics for future studies. Furthermore, since all the VCs in this review are located in the UK, the conclusions drawn may not apply in other countries, especially outside the Anglo-Saxon world. Therefore, future studies conducted outside the UK/Anglo-Saxon world can be an added value.

#### **6. Conclusions**

This literature review examines different implementations of SC and VCs in a hospitalbased setting and compares them with the conventional ophthalmologist-led outpatient service in terms of the QoC delivered, the acceptance and the productivity.

A high acceptance seems to be linked to the reduced waiting time in the clinic and the social skills of some non-medical staff members having contact with the patient. Furthermore, by dividing the workload among the ophthalmologists and the non-medical staff, more patients could enter the glaucoma care pathway and be seen on time. Due to their reduced workload, ophthalmologists could assess new and high-risk patients more rapidly and with access to more auxiliary tests. Progressive glaucoma could be detected earlier, the treatment could be adjusted faster and further damage could be prevented.

In summary, SC and VCs are two promising approaches to tackle the upcoming capacity problems of glaucoma care within a hospital-based setting, without compromising the acceptance and the QoC delivered.

**Author Contributions:** Conceptualization, J.B.-B. and I.S.; methodology, A.-S.S., J.V., J.B.-B. and I.S.; validation, J.B.-B. and I.S.; formal analysis, A.-S.S. and J.V.; investigation, A.-S.S., J.V. and J.B.-B.; resources, I.S.; data curation, A.-S.S. and J.V.; writing—original draft preparation, A.-S.S. and J.V.; writing—review and editing, J.B.-B. and I.S.; visualization, J.B.-B.; supervision, J.B.-B. and I.S.; project administration, J.B.-B.; funding acquisition, I.S. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Conflicts of Interest:** The authors declare no conflict of interest.
