ReVise Study
Research type
Research Study
Full title
Co-designing and evaluating a real-world implementation model for remote consultation with vision self-testing. The ReVise study.
IRAS ID
326502
Contact name
Louise Allen
Contact email
Sponsor organisation
Cambridge University Hospitals NHS Foundation Trust
Duration of Study in the UK
2 years, 6 months, 1 days
Research summary
Summary of Research
Aim: to develop and implement an effective remote eye consultation and vision self-testing service.
Background: NHS eye clinics conduct over 9 million appointments annually. Long backlogs cause avoidable blindness in hundreds of people every year, with ethnic minorities, older people and the poor most at risk. Remote consultation (by video or phone) can help increase service capacity and is generally popular with patients. Advantages include less time off work, less travel and better access to services for rural communities.
Currently, only 5% of eye consultations take place remotely, compared to the 30% NHS target. Every hospital eye consultation starts with a vision test using a letter chart. This is an important indicator of eye health. If vision could be self-tested at home or in the community, more patients could benefit from remote consultation. Self-monitoring could also enable early detection of visual change between appointments. This could encourage patient engagement with their care.
DigiVis is a CE marked online app which enables patients as young as four to accurately test their vision at home. We need to understand how to make remote consultation and vision self-testing as easy to use as possible so that everyone can benefit.
Methods: Using focus group interviews and surveys, we will engage with the staff and patients who will use the service. We will explore the difficulties that patients may have in accessing the technology and design ways of implementing the service to work around these barriers. We will assess how acceptance of the technology changes following implementation of the service model and analyse what is working well and what needs changing.
Dissemination: The optimised service model will be shared to enable successful uptake of the technology throughout the NHS. We will use public and NHS websites, journals and conferences to publicise our study results.Summary of Results
This study was led by eyecare professionals and academic staff at Cambridge University Hospitals NHS trust (the study sponsor) and academics at the University of East Anglia. The study was funded by the National Institute for Healthcare Research i4i Challenge programme.
Hospital eye departments are extremely busy and delayed appointments can cause avoidable vision loss. New online vision applications support accurate vision testing at home and may reduce the need to attend hospital clinics regularly. Some patients may be suitable to have a consultation over the phone or video instead. The aims of this study were to:
1) Work with patients and staff to develop a plan for increasing the safe use of remote consultation and digital home vision testing.
2) See how well this plan worked in practice in three different hospital trusts.
During the study, 74 patients and 46 eye department staff based in Cambridgeshire and Manchester took part in focus groups and surveys to co-design the plan. This plan was put into practice in three NHS trusts based in Cambridge, Peterborough and Manchester.
Two of the three hospital trusts were unable to build remote consultation and home vision testing into their services due to either IT (Information technology) issues or staff rejection. However, the plan was successfully implemented in the childrens’ eye service in Cambridge. In 2024, 410 remote consultations with home vision testing were safely undertaken by this service, creating an additional 205 in-hospital appointments and avoiding 34,333 miles of patient travel.
This study illustrates the barriers to the use of remote consultation and innovative digital home vision testing in NHS hospital eye services. It also shows the potential to reduce the out-patient back-log safely with innovative ways of working. The co-designed implementation will be published to support the future spread of digital innovation to other NHS trusts.
The study team thank the patients and staff who participated in this project.REC name
London - Chelsea Research Ethics Committee
REC reference
23/PR/0915
Date of REC Opinion
6 Sep 2023
REC opinion
Further Information Favourable Opinion