4.3.3. Follow-Up

The non-medical staff working at SMS varied between articles [56–58]. In the pilot study, ophthalmic technicians performed VA, VF and optic disc imaging [56]. An ONP took the patient's history by reviewing a questionnaire and was in charge of the clinical examination, including tests that required more expertise (IOP, slit-lamp examination). Furthermore, they could offer advice on common eye complaints and drop delivery technique. The GE reviewed the notes of previous appointments and included these in the management decisions. In a later study, the ONP was removed from the SMS [57]. A slitlamp examination was no longer performed, and the ophthalmic technicians took over IOP measurement. In the study of Nikita et al., the SMS also incorporated OCT for the virtual review [58]. However, the profession of the non-medical staff was not specified in this article [58]. Similar to the GSC [49], a follow-up patient was evaluated by a clinician who decided if the patient was eligible for the SMS [59]. In the GCC, an optometrist supported by ophthalmic technicians met the patient first and collected clinical data from the clinical history, clinical examination, VF and color optic disc images [51]. After data interpretation, the optometrist classified the patient into one of five risk categories, each associated with a required time interval for a face-to-face consultation with a GE. Subsequently, in the virtual review, the GE confirmed or changed the optometrist's classification, based on the same clinical data. If a patient was classified to have no strong evidence of glaucoma, the patient would be discharged, and would not be seen by a GE [51].
