Denmark put OCT scans in 79 optician stores. Referrals tripled.

Between March 2022 and May 2025, 1,220,082 people had an eye examination in one of the 79 stores of a Danish optician chain, before, during and after each store installed an OCT scanner connected to a consultant-reviewed teleophthalmology service. A study published on 15 September in the European Journal of Ophthalmology, from an 18-author group led from the University of Copenhagen, reports what that did to referrals. They went up, by a lot, and the interesting part is where.

For a UK optometrist the question is no longer whether to own an OCT; Optometry Scotland's survey last year found 80% of Scottish practices already do. It is what happens to the public eye service when a whole high street starts scanning through a pathway that already has a consultant reading the doubtful cases. Denmark has now watched that happen at national scale, in one chain, with no comparison against OCT on its own.

What the study did

It is a nationwide, multi-period observational study of one optometry chain. Every examination in the 79 stores was counted across three periods: before OCT arrived, while it was being rolled out, and after it was in every store. Findings the optometrist was unsure about went to a teleophthalmology service, where a consultant ophthalmologist reviewed the images and the case was triaged: no follow-up, follow-up in the store, follow-up by the service, or referral into the public healthcare system, graded acute, subacute or routine. In Denmark that referral usually goes to a practice-based ophthalmologist, a tier the UK does not have, who gatekeeps the hospital.

The chain is not new to this. The same group described the pathway in 2021, before OCT: in one year, from a pool of 386,361 customers, 9,938 people were sent to the telemedical service, and 80.5% of them were kept out of the national eye care system; 14.4% needed no follow-up at all.

What the OCT scans did to referrals

Monthly submissions to the teleophthalmology service rose from 703 before OCT to 2,359 after full implementation, more than three times as many. Referrals into public healthcare rose from 0.55% to 1.74% of those examined.

The shape of that increase is the finding. Acute referrals were stable. Subacute referrals rose by 178% and routine referrals by 292%. Detection of central serous chorioretinopathy, epiretinal membrane, macular hole and neovascular AMD all increased markedly. The scanner did not flood the emergency clinic; it sent in more suspected disease of the kind that can wait a few weeks, with time to plan.

The authors are careful about attribution. The changes, they write, belong to an integrated model: OCT imaging, standardised acquisition by the optometrist, consultant review and structured triage, together. Not to the OCT on its own.

Why it matters in practice

The scale is what makes this useful. An earlier paper from the same group counted 355,818 different people imaged in the stores in a single year: 5.99% of Denmark's population, and between 8% and 9% of each decade from 41 to 80. Few programmes image six per cent of a population in a year. A high street with OCT and somewhere to send the scan did.

The UK has the scanners. What it mostly lacks is the layer. Where something like it exists, as in a Bristol pathway published in August, community optometrists sent OCT volume scans and fundus photographs for review by a consultant or a hospital optometrist within one working day; 87.0% of 376 macular referrals were appropriate, 73.7% of those avoided the first hospital visit the old pathway required, and wet AMD was treated in a mean of 8.6 days. In Scotland, Optometry Scotland asked last September for a General Ophthalmic Services fee for OCT in acute presentations and capital funding for the scanners. In England, June's £20 million to give every NHS-contracted practice access to the e-Referral service by April 2028 is part of the plumbing such a layer needs: it carries the referral, not the scan.

For a practice, the practical reading is this. When your OCT finds something you are not sure about, is there a consultant at the other end of a secure upload, or only a referral letter? Ask your local eye service which it is. A Danish modelling study put the cost per suspected posterior-segment case at £116 through a general ophthalmologist and £75 to £94 through the teleophthalmology route, with a wait of 25 weeks against under six. Those are Danish figures for a Danish system, and the model predates OCT and assumed the pathway would cut referrals, where the new study shows them rising. What it prices is the review layer, and that direction is not subtle.

The caveats

• Observational, in one chain, and written by the team that runs the service. It is not a randomised comparison.
• More detection is not the same as better outcomes. The study counts referrals and diagnoses, not sight saved, and more routine referrals for epiretinal membrane also means more people told about something that may never need treatment.
• Denmark's chain, public eye service and fees are not the NHS, and the cost figures come from a model, not from the pathway's accounts.
• The full paper is behind a paywall. The figures here are from its abstract and from the group's open-access earlier papers.

Sources

1. 1.Referral patterns after nationwide implementation of OCT-enabled teleophthalmology in optometrist stores in Denmark · European Journal of Ophthalmology, 15 September 2026
2. 2.Tele-ophthalmology for retinal health surveillance in Denmark · Ophthalmology and Therapy, 13 January 2026
3. 3.Danish teleophthalmology platform reduces optometry referrals into the national eye care system · BMJ Open Ophthalmology, 18 March 2021
4. 4.Implementing teleophthalmology services to improve cost-effectiveness of the national eye care system · Eye, 4 June 2024
5. 5.Enhanced macular imaging referral pathway: bridging community optometrists and hospital specialists · Ophthalmology and Therapy, 14 August 2026
6. 6.Optometry Scotland calls for OCT to be integrated into primary eye care in Scotland · Optometry Today, 16 September 2025
7. 7.Millions to get faster eye care on the high street · GOV.UK, 8 June 2026