Referral patterns after nationwide implementation of OCT-enabled teleophthalmology in optometrist stores in Denmark

Purpose: To evaluate changes in opportunistic eye examination and referral patterns after nationwide implementation of Optical coherence tomography (OCT) within an optometrist-based teleophthalmology pathway. Methods: This nationwide multi-period observational study included 1,220,082 individuals examined across 79 Danish optometrist stores between March 2022 and May 2025. Data were analyzed across three periods: before OCT, during implementation, and after full implementation. Outcomes included referral rates to teleophthalmology, diagnostic patterns, and referrals to public healthcare. Results: Monthly referrals to teleophthalmology increased from 703 before OCT to 2,359 after implementation. Detection of macular diseases increased markedly, including central serous chorioretinopathy, epiretinal membrane, macular hole, and neovascular age-related macular degeneration. Referrals to public healthcare rose from 0.55% to 1.74%, with stable acute referrals but substantial increases in subacute (+178%) and routine (+292%) referrals. Conclusions: Nationwide implementation of OCT within an optometrist-based teleophthalmology pathway was associated with increased teleophthalmology submissions, increased detection of selected retinal and optic-nerve conditions, and redistribution of public healthcare referrals towards subacute and routine priorities. These findings should be interpreted as changes within an integrated care model combining OCT imaging, standardized optometrist acquisition, consultant ophthalmologist review, and structured teleophthalmology triage, rather than as the isolated effect of OCT.