Remote ophthalmology with a smartphone adapter handled by nurses for the diagnosis of eye posterior pole pathologies during the COVID-19 pandemic.

Introduction: The use of smartphones to provide specialist ophthalmology services is becoming a more commonly used method to support patients with eye pathologies. During the COVID-19 pandemic, demand for telehealth services such as tele-ophthalmology, is increasing rapidly.Methods: In 2019, the agreement between diagnostic tests was investigated by comparing the diagnostic performance for eye posterior pole pathologies of the images obtained by a smartphone coupled to a medical device known as open retinoscope (OR), handled by a nurse and subsequently assessed by an ophthalmologist versus the images obtained by an ophthalmologist using a slit lamp associated to a 76 diopter indirect ophthalmic lens (Volk Super FieldVR ) (SL-IOL) at the outpatient department of a hospital. The OR used in this study worked with a 28 diopter indirect lens.Results: An examination of 151 dilated eyes (79 adult patients, mean age of 66.7 years, 59.5% women) was conducted. Sensitivity was 98.9%, specificity was 89.8%, the positive predictive value was 93.8% and the negative predictive value was 98.2%. The kappa index between both tests was 0.90 (95% CI: 0.83-0.97) in basic diagnosis, 0.81 (95% CI: 0.74-0.89) in syndromic diagnosis (13 categories) and 0.70 (95% CI: 0.62-0.77) in advanced diagnosis (23 categories).Discussion: Images obtained by a nurse using a smartphone coupled to the OR and subsequently assessed by an ophthalmologist showed a high diagnostic performance for eye posterior pole pathologies, which could pave the way for remote ophthalmology systems for this patient group.

Current situation and prospect of teleophthalmology.

With the development of technology, doctors can diagnose and treat many diseases through telemedicine. At present, teleophthalmology is mainly used in screening and diagnosing some ocular diseases, monitoring chronic ocular diseases, as well as teleconsultation. With the increasing demand and application of teleophthalmology, some problems will gradually become prominent, such as insufficient equipment and staff, medical risks, patient acceptance and satisfaction, network security, privacy, and covering of medical insurance. The global pandemic of COViD-19 has unexpectedly brought telemedicine to the forefront of ophthalmic services, and may continue to change the way of ophthalmic diagnosis and treatment. With the development of artificial intelligence technology, the expansion of 5G communication network coverage, the standardized training of primary medical staff, and the introduction of relevant laws and regulations, teleophthalmology will become more improved, universal, and widely applied, so as to provide patients with sustainable medical services of higher quality.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Accuracy of Mobile-Based Vision Chart in Clinical Practice during the COVID-19 pandemic.

PURPOSE: The accuracy of mobile-based visual acuity testing in clinical practice is debatable. This study aimed to analyze the accuracy of mobile-based distant vision chart in comparison to the standard chart projector. METHODS: In this cross-sectional study, monocular distant best-corrected visual acuity (BCVA) in 571 eyes of 288 subjects was measured twice, using the Tumbling E vision chart by standard chart projector and repeated using mobile-based vision chart application with screen mirroring on a 22-inch monitor. The decimal results of BCVA were compared to analyze the accuracy of the mobile-based chart in comparison to the standard vision chart projector. RESULTS: The mean age of the studied patients was 29 ± 14 years. The most frequent refractive error was hyperopia (35.4%), followed by emmetropia (26.7%), myopia (22.9%), and astigmatism (14.9%). The mean BCVA in decimal form was 0.9 ± 0.2 and 0.91 ± 0.26 by the standard and mobile-based charts, respectively. An excellent agreement was reported between both tests as the intraclass correlation coefficient (ICC) was 0.976, with a confidence interval (CI) of 0.965-0.982. Bland-Altman analysis revealed that most visual acuity differences between both methods lie on the equality line or within the allowed difference zone. CONCLUSIONS: The mobile-based vision chart is an economical, accessible, and accurate way for distant vision assessment, and its results are comparable to the standard chart projector in clinical practice.

Telemedicine in Ophthalmology: Lessons from the COVID-19 Era and Beyond

The progress of information and communication technologies in the era of COVID-19 created an unprecedented opportunity for medicine to adapt to new models of care. Telemedicine and telehealth have enabled medical care at a distance in various fields, including ophthalmology. The aim of this article is to review the current state and the opportunities for telemedicine in ophthalmology. Material(s) and Method(s): PubMed, ScienceDirect Database, Google Scholar databases, as well as official sites of various governmental and non-governmental institutions were explored. The search was conducted between May 1, 2022 and July 31, 2022 using as key words "teleophthalmology";"telemedicine/telehealth and ophthalmology";"ophthalmology and COVID-19". Result(s): 87 primary sources were reviewed. An exploratory analysis of the current state and application of telemedicine in ophthalmology was made. Conclusion(s): A great number of innovations have created an environment allowing for teleophthalmology to flourish, whereas the COVID-19 epidemic has accelerated the development and adoption of these digital technologies. Telemedicine has become an extremely valuable tool during a pandemic, and even if it would never fully replace in the person-to-person patient visits, it certainly has an important role in our dynamic and high-tech world. Copyright © 2023 S. Uzunova et al., published by Sciendo.

Implementation of deep learning artificial intelligence in vision-threatening disease screenings for an underserved community during COVID-19.

INTRODUCTION: Age-related macular degeneration, diabetic retinopathy, and glaucoma are vision-threatening diseases that are leading causes of vision loss. Many studies have validated deep learning artificial intelligence for image-based diagnosis of vision-threatening diseases. Our study prospectively investigated deep learning artificial intelligence applications in student-run non-mydriatic screenings for an underserved, primarily Hispanic community during COVID-19. METHODS: Five supervised student-run community screenings were held in West New York, New Jersey. Participants underwent non-mydriatic 45-degree retinal imaging by medical students. Images were uploaded to a cloud-based deep learning artificial intelligence for vision-threatening disease referral. An on-site tele-ophthalmology grader and remote clinical ophthalmologist graded images, with adjudication by a senior ophthalmologist to establish the gold standard diagnosis, which was used to assess the performance of deep learning artificial intelligence. RESULTS: A total of 385 eyes from 195 screening participants were included (mean age 52.43 ± 14.5 years, 40.0% female). A total of 48 participants were referred for at least one vision-threatening disease. Deep learning artificial intelligence marked 150/385 (38.9%) eyes as ungradable, compared to 10/385 (2.6%) ungradable as per the human gold standard (p < 0.001). Deep learning artificial intelligence had 63.2% sensitivity, 94.5% specificity, 32.0% positive predictive value, and 98.4% negative predictive value in vision-threatening disease referrals. Deep learning artificial intelligence successfully referred all 4 eyes with multiple vision-threatening diseases. Deep learning artificial intelligence graded images (35.6 ± 13.3 s) faster than the tele-ophthalmology grader (129 ± 41.0) and clinical ophthalmologist (68 ± 21.9, p < 0.001). DISCUSSION: Deep learning artificial intelligence can increase the efficiency and accessibility of vision-threatening disease screenings, particularly in underserved communities. Deep learning artificial intelligence should be adaptable to different environments. Consideration should be given to how deep learning artificial intelligence can best be utilized in a real-world application, whether in computer-aided or autonomous diagnosis.

Teleophthalmology in Saudi Arabia.

Teleophthalmology is the provision of ophthalmic care using digital medical equipment and telecommunications technology. While teleophthalmology has been practiced since the 1990s, it became a crucial medical service during the COVID-19 pandemic when doctors were required to make diagnoses from a distance. This was certainly the case in Saudi Arabia, a relatively large country with limited medical workforce to meet demands, yet a high prevalence of diseases such as diabetes, glaucoma, and cataracts which are considered leading causes of visual impairment. In response to the pandemic, Saudi Arabia's Ministry of Health issued scientific instruction manuals and guidelines for health-care providers which paved the way for increased use of digital technologies and solutions to mitigate the health and economic impacts of COVID-19. The pandemic served to accelerate the use of virtual ophthalmology in Saudi Arabia with the most common teleophthalmology applications being teleconsultation and disease-specific applications such as diabetic retinopathy and retinopathy of prematurity. Although some challenges relating to implementing teleophthalmology in Saudi Arabia remain, it is felt that there are great opportunities to expand the use of telemedicine in ophthalmology in this country.

Follow-up Rates After Teleretinal Screening for Diabetic Retinopathy: Assessing Patient Barriers to Care.

Purpose: To study patient follow-up after they engage in a teleretinal screening program and to understand potential barriers to care. Methods: This was a retrospective analysis and a prospective study of telephone-based patient interviews of outpatients screened for diabetic retinopathy (DR) through a teleretinal referral system. Results: Of 2761 patients screened through a teleretinal referral program, 123 (4.5%) had moderate nonproliferative DR (NPDR), 83 (3.0%) had severe NPDR, and 31 (1.1%) had proliferative DR. Of the 114 patients with severe NPDR or worse, 67 (58.8%) saw an ophthalmologist within 3 months of referral. Eighty percent of interviewed patients reported they were not aware of the need for follow-up eye appointments. Conclusions: Of patients with severe retinopathy or worse, 58.8% presented for in-person evaluation and treatment within 3 months of screening. Although this result was negatively affected by factors related to the COVID-19 pandemic, key elements of patient education and improved referral strategies to facilitate in-person treatment are essential to improving follow-up after patients engage in telescreening.

Feasibility Analysis of Teleophthalmology Diagnosis and Referral in Remote Areas of Taiwan.

Background: Remote areas of Taiwan lack routine and specialized ophthalmology services. This study aimed to analyze feasibility of teleophthalmology service for diseases diagnosis and referral in remote areas of Taiwan. Methods: A retrospective study of medical records from 11 remote teleophthalmology clinics in the Taitung area of Taiwan was conducted from May 2020 to December 2021. Vision and intraocular pressure were checked. Ophthalmic imaging was performed by local trained nurses using a hand-held ophthalmoscope and slit lamp biomicroscope. The images were transmitted by telemedicine system to a medical center. Consultation was conducted via face-to-face real-time video calls. Ophthalmologists in the medical center provided diagnosis and treatment advice based on the real-time images and interactive history taking via the telemedicine system. All the images and data were collected and well-reviewed by ophthalmologists in the medical center, and disease prevalence and referral were analyzed for the program. A small-scale satisfaction questionnaire survey was conducted for efficacy evaluation of the program. Results: A total of 1,401 medical records from 1,094 patients were collected and screened. Patients' ages ranged from 9 months to 94 years, with a mean age of 57.27 (standard deviation ±20.47) years. The most frequent ophthalmologic diagnosis was dry eye disease (20.2%), followed by conjunctivitis (12.4%). Among 322 patients with underlying diseases of diabetes mellitus, 59 patients (18.3%) were diagnosed with diabetic retinopathy. Major diagnosis was made in 102 patients (7.3%) and referral to hospital for further management was suggested. This program had high overall satisfaction score of 89% (mean 4.43 ± 0.52 points) in satisfaction questionnaire survey. Conclusion: Teleophthalmology provides an alternative tool for ocular disease diagnosis and screening for patients in remote areas, especially during the COVID-19 pandemic. This service helps to detect major but undiagnosed diseases and promotes health care accessibility and availability in remote areas that lack specialists.

Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care.

Purpose of Review: In this article, we reviewed the impact resulting from the COVID-19 pandemic on the traditional model of care in ophthalmology. Recent Findings: Though virtual eye care has been present for more than 20 years, the COVID-19 pandemic has established a precedent to seriously consider its role in the evolving paradigm of vision and eye care. New hybrid models of care have enhanced or replaced traditional synchronous and asynchronous visits. The increased use of smart phoneography and mobile applications enhanced the remote examination of patients. Use of e-learning became a mainstream tool to continue accessing education and training. Summary: Teleophthalmology has demonstrated its value for screening, examining, diagnosing, monitoring treatment, and increasing access to education. However, much of the progress made following the COVID-19 pandemic is at risk of being lost as society pushes to reestablish normalcy. Further studies during the new norm are required to prove a more permanent role for virtual eye care.

Factors Associated with Follow-Up Adherence After Teleophthalmology for Diabetic Eye Screening Before and During the COVID-19 Pandemic.

Abstract Background: Follow-up adherence with in-person care is critical for achieving improved clinical outcomes in telemedicine screening programs. We sought to quantify the impact of the COVID-19 pandemic upon follow-up adherence and factors associated with follow-up adherence after teleophthalmology for diabetic eye screening. Methods: We retrospectively reviewed medical records of adults screened in a clinical teleophthalmology program at urban and rural primary care clinics between May 2015 and December 2020. We defined follow-up adherence as medical record documentation of an in-person eye exam within 1 year among patients referred for further care. Regression models were used to identify factors associated with follow-up adherence. Results: Among 948 patients, 925 (97.6%) had health insurance and 170 (17.9%) were referred for follow-up. Follow-up adherence declined from 62.7% (n = 52) prepandemic to 46.0% (n = 40) during the pandemic (p = 0.04). There was a significant decline in follow-up adherence among patients from rural (p < 0.001), but not urban (p = 0.72) primary care clinics. Higher median household income (odds ratio [OR] 1.68, 95% confidence interval [CI]: 1.19-2.36) and obtaining care from an urban clinic (OR 5.29, 95% CI: 2.09-13.43) were associated with greater likelihood of follow-up during the pandemic. Discussion: Follow-up adherence remains limited after teleophthalmology screening even in a highly insured patient population, with a further decline observed during the COVID-19 pandemic. Our results suggest that rural patients and those with lower socioeconomic status experienced greater barriers to follow-up eye care during the COVID-19 pandemic. Conclusions: Addressing barriers to in-person follow-up care is needed to effectively improve clinical outcomes after teleophthalmology screening.

Implementation of Developed Esantem Smart Healthcare System in Metaverse

The advancement of digital transformation in virtual healthcare technologies have increased exponentially, creating a diverse range of state-of-The-Art devices and software to optimize the revealed limitations within the healthcare industry. The recent trends in virtual healthcare was enhanced during COVID-19 pandemic which fostered the development of metaverse, a virtual space that forms digital identities and interfaces consisting of an interconnected network of digital devices. Metaverse can act as multi-scale layer of advanced computer-human interaction and can provide new opportunities for digitalized healthcare system. It can provide a wide range of assistance through medical examinations, meetings regarding mental well-being, and clinical appointments. Since the patient medical data is fully digitalized, metaverse offers a space in which artificial intelligence and augmented reality-Assisted telehealth can function optimally. The accurate medical data provided by the wearable biomedical devices with the integration of metaverse and augmented reality technologies is becoming the efficient way of the telemedicine approach. While the digitalization of healthcare system within metaverse can ease the burden on conventional healthcare, the security of digital patient medical data becomes one of the main concerns for the proposed metaverse implementations. In this study, several aspects of the proposed implementation process of the embedded Esantem smart healthcare system in the metaverse, including the adaptations of conventional healthcare in metaverse, the opportunities for advanced human-computer interaction, and the handling of wearable biomedical device medical data and its security in a digital environment are examined. In addition, the main limitations against the development of such an implementation are unveiled with possible solutions such as blockchain for the security of patient data for future research directions. © 2022 IEEE.

Tele-ophthalmology for age-related macular degeneration during the COVID-19 pandemic and beyond.

INTRODUCTION: COVID-19 has disrupted how ophthalmic practice is conducted worldwide. One patient population that may suffer from poor outcomes during the pandemic are those with age-related macular degeneration (AMD). Many practices are performing some form of tele-ophthalmology services for their patients, and guidance is needed on how to maintain continuity of care amongst patients with AMD using tele-ophthalmology. METHODS: A literature search was conducted, ending 1 August 2020, to identify AMD outcomes and telecare management strategies that could be used during the COVID-19 pandemic. RESULTS: 237 total articles were retrieved, 56 of which were included for analysis. Four American Academy of Ophthalmology and Center for Disease Control web resources were also included. DISCUSSION: Risk-stratification models have been developed that let providers readily screen existing patients for their future risk of neovascular AMD (nAMD). When used with at-home monitoring devices to detect nAMD, providers may be able to determine who should be contacted via tele-ophthalmology for screening. Telemedicine triage can be used for new complaints of vision loss to determine who should be referred to a retinal specialist for management of suspected nAMD. To increase access and provider flexibility, smartphone fundus photography images sent to a centralized tele-ophthalmology service can aid in the detection of nAMD. Considerations should also be made for COVID-19 transmission, and tele-ophthalmology can be used to screen patients for the presence of COVID-19 prior to in-person office visits. Tele-ophthalmology has additional utility in connecting with nursing home, rural, and socioeconomically disadvantaged patients in the post-pandemic period.

Stakeholder perceptions affecting the implementation of teleophthalmology.

PURPOSE: Teleophthalmology has become the subject of heightened interest and scrutiny in the wake of the SARS-CoV-2 global pandemic. A streamlined implementation framework becomes increasingly important as demand grows. This study identified obstacles to teleophthalmology implementation through summative content analysis of key stakeholders' perceptions. DESIGN: Summative content analysis of transcribed interviews with key stakeholders (including patients, technicians, ophthalmic readers, staff, nurses, and administrators at two teleophthalmology clinic sites). METHODS: Keyword Were counted and compared to examine underlying meaning. Two analysts coded text independently using MAXQDA for summative qualitative content analysis to derive themes and hierarchical relationships as a basis for future refinement of TECS implementation. xMind ZEN was used to map conceptual relationships and overarching themes that emerged to identify perceived facilitators and barriers to implementation RESULTS: Analysis revealed two themes common to perceptions: (1) benefits of care, and (2) ease of implementation. Perceived benefits included efficiency, accessibility, and earlier intervention in disease course. The quality and quantity of training was heavily weighted in its influence on stakeholders' commitment to and confidence in the program, as were transparent organizational structure, clear bidirectional communication, and the availability of support staff. CONCLUSION: Using a determinant framework of implementation science, this report highlighted potential hindrances to teleophthalmology implementation and offered solutions in order to increase access to screening, improve the quality of care provided, and facilitate sustainability of the innovation.

Digital innovations for retinal care in diabetic retinopathy.

AIM: The purpose of this review is to examine the applications of novel digital technology domains for the screening and management of patients with diabetic retinopathy (DR). METHODS: A PubMed engine search was performed, using the terms "Telemedicine", "Digital health", "Telehealth", "Telescreening", "Artificial intelligence", "Deep learning", "Smartphone", "Triage", "Screening", "Home-based", "Monitoring", "Ophthalmology", "Diabetes", "Diabetic Retinopathy", "Retinal imaging". Full-text English language studies from January 1, 2010, to February 1, 2022, and reference lists were considered for the conceptual framework of this review. RESULTS: Diabetes mellitus and its eye complications, including DR, are particularly well suited to digital technologies, providing an ideal model for telehealth initiatives and real-world applications. The current development in the adoption of telemedicine, artificial intelligence and remote monitoring as an alternative to or in addition to traditional forms of care will be discussed. CONCLUSIONS: Advances in digital health have created an ecosystem ripe for telemedicine in the field of DR to thrive. Stakeholders and policymakers should adopt a participatory approach to ensure sustained implementation of these technologies after the COVID-19 pandemic. This article belongs to the Topical Collection "Diabetic Eye Disease", managed by Giuseppe Querques.

Applications of Telemedicine in the Middle East and North Africa Region: Benefits Gained and Challenges Faced.

Information and communication technology has left a print on all fields of life, including medicine and the health care system. Telemedicine is the perfect way to ensure adequate healthcare delivery to all people at any time, particularly during pandemics, regardless of any geographic or economic considerations. This article investigates the different types, categories, and benefits in addition to the barriers to telemedicine implementation, especially in the Middle East and North Africa (MENA) region. After a thorough review of medical literature related to telemedicine using PubMed, Google Scholar, and some other gray literature, it has been found that telemedicine has been involved in almost all medical specialties with a positive influence on healthcare delivery and medical education and research. It had a major role during the COVID-19 pandemic. However, many obstacles prevent its proper application and need to be addressed carefully by the government and relevant authorities. Due to the rapidly growing population, unequal distribution of healthcare services, and social distancing of the COVID-19 pandemic, the role of telemedicine has become increasingly essential. Regarding medical education and research, telemedicine facilitates the exchange of information and ideas between physicians and professionals from all over the world, bringing these various minds together on a single platform.

The Prevalence of Teleophthalmology in the Piedmont Region of Italy: Current Situation and Future Perspectives.

PURPOSE: This cross-sectional study aims to evaluate the actual prevalence of telemedicine, with a particular attention to teleophthalmology programs, in the Piedmont region of Northern Italy and investigate the prospects of the discipline, comparing the situation with the rest of Italy. Information about the current teleophthalmological development is important to assess the state-of-the-art of innovation in medicine in different areas of the world so that there can be a healthy comparison and evaluation of progress and backlog. METHODS: We sent questionnaires to every Local Healthcare Authority and gathered the answers in five distinct categories. Due to the COVID-19 pandemic, we collected information by telephone. We investigated five primary areas: what type of telemedicine services are currently in operation, how they are managed, the presence of any evaluation of patient satisfaction and cost-savings, and the prospects of future teleophthalmology programs to be implemented. RESULTS: Only 2% of the total telemedicine programs are in the field of ophthalmology. The greater parts are in the field of cardiology (15%) and endocrinology (13%). Currently, only one program of teleophthalmology exists in the territory, and at least four more projects are waiting to be approved or funded. Surveys about patient satisfaction were not provided and there was no evidence of cost-saving. CONCLUSIONS: Teleophthalmology in Piedmont is slowly developing, although there is a lack of a unified network for storing and managing patients' data. During the COVID-19 pandemic, telemedicine usage drastically increased, and there is a need to evaluate this trend to understand its place in the future of medicine.

Comparison of smartphone application-based visual acuity with traditional visual acuity chart for use in tele-ophthalmology.

PURPOSE: The aim of this study was to compare the visual acuity (VA) by smartphone-based applications - EyeChart and the Peek Acuity to the standard Snellen chart to explore the possibility of using them as an alternative in tele-ophthalmology in the current COVID-19 pandemic. MATERIALS AND METHODS: An analytical type of observational study was done on 360 eyes of 184 patients above 18 years of age. Patients with VA <6/60 and gross ocular pathology were excluded from the study. VA measured by these three methods was converted to logMAR scale for ease of statistical analysis. One-way analysis of variance with post Tukey HSD was used to compare the VA measured by these three methods. RESULTS: There was no statistically significant difference between VA measured using the smartphone-based apps (EyeChart and Peek Acuity) and the Snellen chart (F = 2.5411, P = 0.7925) in 360 eyes assessed. VA measured by Peek Acuity (P = 0.5225) was more comparable to Snellen chart than EyeChart (P = 0.4730). Intraclass correlation coefficient (ICC) demonstrated a strong positive correlation for EyeChart (ICC: 0.982, P < 0.001) and Peek Acuity (ICC: 0.980, P < 0.001) with Snellen chart. A Bland-Altman difference plot showed good limits of agreement for both EyeChart and Peek Acuity with Snellen chart. In subgroup analysis, VA measured by Peek Acuity was not statistically different from Snellen in any subgroups, but in EyeChart, it was statistically different in emmetropes. CONCLUSION: VA measured by smartphone apps (EyeChart and Peek Acuity) was comparable with traditional Snellen chart and can be used as an effective, reliable, and feasible alternative to assess VA in tele-ophthalmology.

Asynchronous Teleophthalmology for Monitoring Glaucoma Patients in a Rural German Region: A Retrospective Observational Pilot Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has created an escalating need for limiting in-person examination and potential viral exposure. Under these circumstances, teleophthalmology allows ophthalmologists to continue providing care to patients while ensuring their safety and that of the medical staff. OBJECTIVE: The primary objective of this study was to assess patient satisfaction with an asynchronous teleconsultation for glaucoma patients in a rural German area. Secondary endpoints were patient adherence and the need to change the therapeutic regime. METHODS: This retrospective, observational, and monocentric study included 50 patients diagnosed with primary open-angle glaucoma (n = 49) and ocular hypertension (n = 1) requiring medication to lower intraocular pressure (IOP). Only patients with well-controlled diseases were included, and a brief questionnaire was evaluated, which was completed one year after the baseline visit. Best-corrected visual acuity (BCVA), IOP measurements, visual fields, optical coherence tomography images of the optic nerve head, ultra-widefield photographs of the fundus, and photographs of the anterior segment of the eye were taken at each visit by an experienced optometrist. RESULTS: Of the 50 patients included, the mean number of follow-up visits in this observation period was 4.4. No patient was lost to follow-up, and there were a total of nine missed follow-up visits (but not lost to follow-up). No patients required a change in their treatment regime during the observational period. Regarding patient-focused assessment, the majority of patients were satisfied or very satisfied with teleconsultation in general. CONCLUSION: Asynchronous teleophthalmology is a promising option and effective means to monitor glaucoma patients. The majority of teleophthalmology patients were satisfied with their teleconsultation and adhered to the follow-up schedule. However, prospective trials with a larger number of patients and a more focused examination on specific patient populations are required. Further trials should also focus on the aspect of cost-effectiveness.

Physician Satisfaction With Virtual Ophthalmology Clinics During the COVID-19 Pandemic: A Tertiary Eye Care Center Experience.

Background In this study, we aimed to assess ophthalmologists' experience with teleophthalmology during the coronavirus disease 2019 (COVID-19) pandemic in the central region of Saudi Arabia. In addition, we evaluated their satisfaction level and explored their satisfaction determinants. Methodology We conducted an online survey for ophthalmologists who participated in the virtual ophthalmology clinic during COVID-19 between November 2020 and September 2021. The survey was used to evaluate ophthalmologists' experience with teleophthalmology during the pandemic. Ophthalmologists were asked to measure their satisfaction with equipment and technical issues, communication, and clinical assessment, and to provide an overall program evaluation. Data were analyzed via frequency measures (e.g., numbers, percentages, mean, and standard deviation). Results Out of the 113 ophthalmologists who were invited to participate in our study, 71 completed the survey. In total, 23 (32.4%) participants were general ophthalmologists, 15 (21.1%) were subspecialists in the cornea, 16 (22.5%) were subspecialists in glaucoma, one (1.4%) was a subspecialist in neuro-ophthalmology, seven (9.9%) were subspecialists in pediatric ophthalmology, eight (11.3%) were subspecialists in the retina, and one (1.4%) participant was a subspecialist in oculoplastic. Overall, 56.3% of the respondents were satisfied with teleophthalmology. Ophthalmologists who subspecialized in the retina demonstrated higher levels of satisfaction than other subspecialties. The most common challenge reported by ophthalmologists in the virtual consultation was the lack of adequate equipment to evaluate the patients (53.5%), followed by technical issues (43.7%) and the patients' lack of experience in using virtual consultation services (38%). Overall satisfaction score was the highest among ophthalmologists who reported providing at least five video consultations before the survey. Conclusions The findings from our study suggest that the subspeciality of ophthalmologists and the number of video consultations conducted by ophthalmologists are important determinants in their level of satisfaction with teleophthalmology. The majority of the respondents were satisfied with the virtual clinic during the COVID-19 pandemic. The current pandemic could pave the way for the future use of telemedicine in ophthalmology if virtual eye examinations become standardized.

Tele-Ophthalmology Practices and Attitudes in the Philippines in Light of the COVID-19 Pandemic: A Survey.

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) pandemic has limited patient access to out-patient care, prompting many clinicians to incorporate telemedicine in their practice. This study aims to explore the impact of the pandemic on the use of tele-ophthalmology in the Philippines. METHODOLOGY: A 30-item online survey on practices and attitudes related to tele-ophthalmology was sent to ophthalmologists and ophthalmologists-in-training all over the Philippines. RESULTS: A total of 327 local ophthalmologists responded to the anonymous survey. Reported use of tele-ophthalmology increased from 53% to 90% (P < 0.001) at the time of the COVID-19 pandemic. Social media messaging was the most employed modality, utilized by 8 out of 10 tele-ophthalmology users. Respondents reported confidence in diagnosing gross conditions of the eye, and lack of confidence in diagnosing posterior pole conditions and orbital fractures. The majority (84%) believe that it can be adopted on a wider scale in the upcoming years. CONCLUSION: The pandemic catalyzed a nationwide increase in the utilization of tele-ophthalmology. The majority of respondents expressed willingness to continue incorporating tele-ophthalmology in their practice after the pandemic.