Since 2006, the NHS’ long-term plans have consistently advocated and resourced telemedicine. The current 10-year plan that was announced in 2019 aimed to cut face-to-face outpatient visits by one-third by 2024, by adopting digital consultations. The NHS plan calculates that this single telemedicine shift would save patients 30 million clinic visits a year, preventing millions of miles of travel and significantly lowering the NHS' carbon footprint.
Ophthalmology services across the country have embedded the concept in their practice and have created virtual clinics for the management of retinal diseases, glaucoma and hydroxychloroquine retinopathy monitoring, to name a few.
Are our virtual clinics truly telemedicine?
Telemedicine is a process by which the patient accesses healthcare from a location that is remote to the clinical setting, aided by technology like video conferencing. Most of our virtual clinics are asynchronous consultations best described as a hybrid ‘store-and-forward’ model [1]. The patient still must attend the hospital site for tests and image acquisition. The information gathered is then reviewed by the clinician and the results and management plan are communicated to the patient.
The benefits of the clinics include significant time saving from shortened hospital visits and the elimination of waiting to see the doctor, reduced appointment delays (ideal for rapid access clinics) and better utilisation of a clinician’s time in that, more patients have their management plans made during any given time period. The drawbacks include the lack of human interaction, unsuitability for complex cases and the technology glitches or poor acquisitions that limit the usefulness of the acquired data.
The carbon impact of virtual vs live clinics
Notwithstanding the increase in efficiency and utilisation of a clinician’s time, the green impact of these clinics deserves more scrutiny. Although dependent on the distance and mode of travel, a patient’s trip to the hospital is around 1.5–5kg of carbon dioxide-equivalent CO2e per one-way visit [2]. This is constant, regardless of it being a virtual or live consultation. By their very nature, the assessment of images lends itself to remote working and where appropriate, it has the potential to save a clinician’s journey to the hospital. There is no further reduction in the carbon footprint to be had in this workflow.
Moving closer to true tele-ophthalmology
Given that the impact on the environment of virtual clinics is, at best, modest, there are emergent technologies which have the capability of pushing it further
Diagnostic hubs
Mobile or community diagnostic hubs where basic investigations like intraocular pressure check, visual fields, optical coherence tomography and fundus imaging carried out by a technician is a way to take care closer to home and reduces the travel for each patient.
Artificial intelligence
AI has the potential for reduction in human endeavour and their attendant carbon footprint in the diagnostic workflow. FDA-cleared and CE-marked algorithms (such as IDx-DR) are being adopted across the globe for diabetic retinopathy screening. Researchers at Moorfields Eye Hospital and University of London have identified, through large-scale testing (trials evaluating 1.2 million images), that commercial AI algorithms achieved an astonishing 96.7% to 99.8% accuracy in identifying moderate-to-severe diabetic eye disease [3]. Deep learning-based AI systems are so advanced in detecting the transformation from dry to wet AMD, in that, the AI system is capable of overcoming substantial interobserver variability in expert predictions, performing better than five out of six experts [4].
Conclusion
The virtual clinics, as they are currently largely run, address some of the capacity gaps in ophthalmology services but offer very little reduction in the carbon footprint for the NHS. The need for advanced diagnostic technology to enable assessment has been the main limiting factor for ophthalmology. Future strides, however, have the potential to take us closer to true tele-ophthalmology in the UK.
Get in touch
We would like to hear from departments that offer ‘virtual plus’ consultations – defined by true reductions in patient journeys, to showcase to our readership.
References
- Jiang SW, Flynn MS, Kwock JT, Nicholas MW. Store-and-forward images in teledermatology: Narrative Literature Review. JMIR Dermatol 2022;5(3):e37517.
- Olsen JR, Nicholls N, Tran TQB, et al. Transition towards healthcare ‘net zero’: modelling condition-specific patient travel carbon emission estimations by transport mode in a retrospective population-based cohort study, Greater Glasgow, UK. BMJ Open 2025;15:e107016.
- Rudnicka A, Shakespeare R, Chambers R, et al. Automated retinal image analysis systems to triage for grading of diabetic retinopathy: a large-scale, open-label, national screening programme in England. Lancet Digit Health 2025;7:100914
- Yim J, Chopra R, Spitz T, et al. Predicting conversion to wet age-related macular degeneration using deep learning. Nat Med 2020;26:892–9.
