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As a result of COVID-19, a new approach for delivering eye care services to rural underprivileged areas were needed to improve eye disease outcomes. Sitapur Eye Hospital used a door-to-door model of medical delivery to alleviate the inability of rural residents from not receiving appropriate eye care during the COVID-19 pandemic. Sitapur Eye Hospital utilizes a healthcare delivery model that involves visiting patients door-to-door. The total number of patients that Sitapur Eye Hospital examined went from screening no patients in the months of April and May to screening 31,017 patients via the door-to-door service that was implemented in June 2020. Sitapur Eye Hospital managed to keep the prevalence of people who had severe eye impairment at pre-pandemic levels by offering a door-to-door service to patients who were unable to access appropriate medical care. The door-to-door healthcare model shows that leveraging telehealth and ride-hailing services alleviate certain barriers that make it difficult for people in rural areas to access eye care.
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During the 2020-21 academic year, COVID-19-related educational disruptions impacted school-based vision screenings. However, limited information regarding changes in vision screening and the number of students impacted has been reported. Delayed screenings can negatively impact students' referral to eye care providers, which may affect a child's ability to see clearly and academic success. This study aims to describe changes in school-based vision screening practices through a survey of National Association of School Nurses state representatives (n = 49). Among states with vision screenings mandates, participants reported that 23.7% (9/38) states waived screenings, 31.6% (12/38) continued screenings, and 36.8% (14/38) modified requirements, such as grades screened or assessments included (e.g., color vision and stereoacuity screenings). These results suggest that millions of students across the United States missed vision screenings during the 2020-21 academic year. Efforts by education and school health stakeholders should be directed towards addressing the pandemic-related disruption in vision screening.
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The recent outbreak of the coronavirus disease of 2019 (Covid-19) has been causing many disruptions among the education systems worldwide, most of them due to the abrupt transition to online learning. The sudden upsurge in digital electronic devices usage, namely personal computers, laptops, tablets and smart-phones is unprecedented, which leads to a new wave of both mental and physical health problems among students, for example eye-related illnesses. The overexpo-sure to electronic devices, extended screen time usage and lack of outdoor sun-light have put a consequential strain on the student's ophthalmic health because of their young age and a relative lack of responsibility on their own health. Failure to take appropriate external measures to mitigate the negative effects of this process could lead to common ophthalmic illnesses such as myopia or more serious conditions. To remedy this situation, we propose a software solution that is able to track and capture images of its users' eyes to detect symptoms of eye illnesses while simultaneously giving them warnings and even offering treatments. To meet the requirements of a small and light model that is operable on low-end devices without information loss, we optimized the original MobileNetV2 model with depth-wise separable convolutions by altering the parameters in the last layers with an aim to minimize the resizing of the input image and obtained a new model which we call EyeNet. Combined with applying the knowledge distillation technique and ResNet-18 as a teacher model to train the student model, we have suc-cessfully increased the accuracy of the EyeNet model up to 87.16% and support the development of a model compatible with embedded systems with limited computing power, accessible to all students. © The Authors.
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COVID-19 was a wake-up call, changing the world we know and our experiences in every possible way. Healthcare systems, as the most exposed and stressed in this situation, were called to urgently respond to the new reality. Physical distancing and stay-at-home directives have flattened the curve and decreased the risk of viral transmission but also decreased the clinical volume in eye care medical practice. Hospitals must work hard to find a balance in responding to the pandemic while providing quality care and positive patient experiences. Previous research on crises has been mostly focused on implementing crisis management strategies to handle the threat against citizens' health, within a relatively bounded geographic area. Novel COVID-19 virus struck globally and urged the need for additional knowledge and practice to successfully manage world crises and create positive patient experiences in a pandemic. The Case of Eye Hospital Sistina Oftalmologija in N. Macedonia answers the call by suggesting four managerial best practices that provide its patients with positive experiences during the pandemic by addressing organizational changes, engaging employees, improving communication with patients and recognizing its social responsibilities. This study also offers recommendations for further action in communication and digital transformations related to acute and long-term care and suggests questions for further exploration. Findings provide important insights for medical institutions and health care providers. © The Author(s), 2020.
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Filipino-Americans are the third largest Asian-American population, with a median age of 44. However, there is limited literature focusing on the group's ophthalmic care engagement. Timely eye examinations and outreach are necessary to reduce visual impairment in this older community. To assess eye care knowledge, attitudes, and practices, we conducted a cross-sectional study surveying Filipino-Americans within the nine San Francisco Bay Area counties. Associations between primary outcomes and sociodemographic factors were analyzed using chi-squared analysis and student's T-test. In our convenience sample of 256 surveys, a majority of participants are receiving appropriate eye care; those that lacked health and eye insurance, immigrated and are lower income did not receive optimal eye care. Study participants also demonstrated a lack of awareness of eye diseases and risk factors. Our results suggest that culturally sensitive eye health education materials are lacking and should be made accessible for this large and rapidly growing population.
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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.
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Purpose: To access knowledge, attitude, and practices of Eye care practitioners (ECPs) towards COVID-19 guidelines and to determine their knowledge about use of Personal Protective Equipment (PPE). Methods: A cross-sectional study was conducted in Tertiary Eye Hospitals of Rawalpindi and Islamabad from October 2020 to March 2021. A total of 270 Eye care practitioners currently working in public and private hospitals were included in this study. Non-probability convenient sampling technique was used. Data was collected from individuals through an interview-based questionnaire after taking consent. Data was coded and analyzed by using SPSS version 26. The Chi-square test was used for further analysis. Results: Mean age of participants was 29.85 ± 7.482 years, ranging from 18 to 65 years. Females (67%) were slightly out-numbered than males of the total sample. Moreover, 50% of the respondents had adequate knowledge about COVID-19 while only 39.3% had a positive attitude towards COVID-19. Hours of practice and years of experience had an association with knowledge. Good practices were observed by only 43.3% of the total sample. Practices had an association with the department of work of ECPs. Conclusion: There is scarcity of knowledge among ECPs about COVID-19 and its preventive measures. Less than 50% ECPs with positive attitude and good practices towards COVID-19 indicate a dire need to train them for use of PPEs. [ FROM AUTHOR]
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Purpose: Persisting inequity in access to eye care for Aboriginal and Torres Strait Islander Australians has been well documented. Over the past decade, a number of frameworks and initiatives have worked towards improving access to eye care, though inconsistent data reporting and availability makes it challenging to form a coherent overview of actual increases in access, and progress towards the population-based needs. The paper will present an improved understanding of access to cataract surgery for Aboriginal and Torres Strait Islander Australians. Method(s): Publicly available cataract surgical data over the past decade, including Medicare statistics, public hospital data, Australian Institute of Health and Welfare annual Indigenous Eye Health Measures reports, state health data, and past analyses in the literature, is combined and analysed to present an overview of existing surgical delivery and access and a more nuanced consideration of cataract surgery needs for Aboriginal and Torres Strait Islander Australians. Result(s): Large variance has been identified across jurisdictions, across public and private settings, and across remoteness levels, suggesting significant differences in access. The combined analysis highlights challenges in access for cataract surgeries in metropolitan areas. Finally, impacts of COVID-19 on service provision and the existing backlog is considered. Conclusion(s): Differing access rates provide an ongoing challenge to organised ophthalmology, as well as the wider eye care sector and national, state and territorylevel programs and policies. The shared goal is to best support increasing the cataract surgery rates for Aboriginal and Torres Strait Islander Australians to populationbased needs.
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PURPOSE: Lockdown guidelines during COVID-19 pandemic increased the e-learning methods and gadgets use, basically to undergo classes, recreation procedures and media news updates, which subsequently upsurgedasthenopic symptoms as digital eye strain (DES) epidemic amid COVID-19 lockdown. This is a descriptive cross-sectional questionnaire based study which is aimed to assess the prevalence, risk factors.Pattern of gadgets used, screen time and symptomatology of Digital eye strain among medical students, teaching doctor faculties and paramedical staff during COVID-19 lockdown at BBMCH, Balangir. METHODS: This e-filled self survey analysed 570 responses from medical students of online classes(200), teachers of online classes (38), paramedical staff (122) and general population(210) .Aprevalidated CVS-Q and OSDI questionnaire regarding screen time spent, was used to calculate the DES score. Median DES Score was compared by medians or non-parametric tests. Categorical variables were compared by Chi Square test and predictors of DES were found by binary logistic regression. SPSS Version 21.0 was used to interpret and analyse the collected data. RESULTS: Majority of survey participants(78%) had at least one symptom of digital eye stain;The reported symptoms during electronic device usage in decreasing frequency were Eye fatigue(65%), Eye strain(52%), Ocular discomfort(50%), headaches(48%), Burning eyes(42%), and Dry eyes(35%), watering(34%), shoulder pain(30%) DES symptoms were found to be more than that of dry eye symptoms. The prevalence of DES in students taking e-learning surpassed to those found with other health staff and general population. DES score was also observed to be on higher side for more screen time users, use of gadgets in dark, screen distance<25cm. Lens or spectacle users suffered worsening of vision and needed change of glasses. No association between DES and exacerbation of pre-existing dry eyes and eye diseases were appreciated due to exclusion of such participants from our survey. CONCLUSION:Eye care tips are needed at periodic intervals to create awareness and to reduce eye strain symptoms, closing of eyes on regular basic, maintaining reading distance between 25-30cm and reducing screen time by breaks can lessen the prevalence of DES. As because, use of gadgets were the major media for learning or communication, so ocular health, hygiene and practical precautions should be kept in mind.
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Objective: To assess the effectiveness of an online educational video in improving contact lens (CL) care knowledge and behavior. Methods: Participants completed a 47-item questionnaire on their CL hygiene knowledge and wear and care behavior. A 5-min CL educational video was shown, and participants completed a post-test. After 2 months, the same questionnaire was used to determine knowledge retention and behavioral changes. Descriptive statistics and McNemar's tests were performed. Results: The mean age of the 132 enrolled participants was 24 years, and 61% were female. The knowledge scores significantly improved after watching the educational video (p < 0.001). Two months after the intervention, the participants reported changes in their hygienic behavior (p < 0.001). Conclusions: Online video-based learning is an effective educational tool for improving the knowledge and behavior of CL care. Practice implications: Patient education via online videos is an innovative and successful strategy that raises awareness, increases patient knowledge, and encourages preventative health behavior to avoid CL-related complications.
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Purpose : The most common cause of blurry vision in the United States is refractive error. Despite being a correctable condition, over 8.2 million people are estimated to have their refractive error go undiagnosed or untreated. Minorities and low-income groups in particular have significantly increased odds of inadequate correction and double the rates of near-vision impairment. We aimed to address this gap in care through the provision of refractive glasses during community-based tele-ophthalmology screenings. Methods : Eight free eye screening events were held in Newark and West New York, NJ. Demographic information, intraocular pressure, visual acuity, auto-refraction, retinal imaging, and optical coherence tomography were obtained from each subject as part of a comprehensive tele-ophthalmology protocol. Reading glasses were provided as needed based on the recommendation of a certified telemedicine reader. Eligible recipients completed surveys on site regarding access to eye care. They were surveyed again by phone after one month to assess degree of satisfaction and vision improvement. Results : 38 subjects (mean age 53, 47% male) qualified for presbyopia correction and received reading glasses. 97% were Hispanic and 3% were African American. Of the 33 that returned surveys, 88% reported not seeing an eye doctor annually. The most common reason was lack of insurance or inability to pay (71%). Others included having no need to see an eye doctor (10%), disliking eye doctors (7%), not knowing the importance of regular eye exams (3%), and COVID-19 (3%). Of the 25 subjects that were reached for follow-up, 92% reported using the glasses daily. Those that did not reported the power was too strong or they did not feel they needed them. Subjects noted an average improvement in vision of 4.4 out of 5 and an average satisfaction of 4.7 out of 5 (Figure 1). Conclusions : Glasses distribution is an effective way to address refractive error in underserved communities. Given the gaps in knowledge and utilization of eye care identified in our study, there is an obvious need for continued outreach to these areas. Further studies will include larger populations and evaluate mobile refraction devices to increase ease and reach of glasses provision.
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Purpose : To gauge the impact of healthcare technology in the management of diabetic retinopathy during the COVID-19 pandemic. Methods : The study was conducted at EyeCare Consultants of New Jersey's in their two locations in NJ, Woodland Park and Edison. Eye care professionals (ECPs-two ophthalmologists, one optometrist) surveyed 400 diabetic patients during the first year of the pandemic (March 2020- February 2021). The patients all received previous instructions with CheckedUp, a patient education digital platform utilizing audiovisual and touchscreen to further educate patients, during in-office visits. The 400 diabetic patients were divided equally into two groups. To ensure the adherence of dietary and behavioral modifications related to diabetes mellitus, Group 1 received traditional phone calls while Group 2 received video calls and supplementary education with CheckedUp. Both groups had a follow-up in person in September 2021. Surveys elicited responses to gauge consistency of HbA1C management. Results : Adherence was defined as HbA1C values which remained within a target value lower than or equal to their baseline and/or <7.0% as well as compliance with medications, dietary restrictions, regular physical activity and follow-up visits. The results found a significant difference between educating the patient with a phone call versus a video call and CheckedUp. At the next follow-up visit in person: Group 1 had an adherence of 48% (96 patients) and had several patients with HbA1C values exceeding the targeted value. Group 2 had an adherence of 69% (138 patients) and were more compliant with a healthier lifestyle. They also stated that their telehealth appointment with CheckedUp helped reinforce the importance of maintaining a normal HbA1C value. Conclusions : This study illustrates the ability of digital medicine platforms to supplement virtual and in-person consultations to manage diabetic retinopathy, especially during the pandemic. Compliance is an important matter in the management and preventing progression of diabetic retinopathy. Digital tools like CheckedUp assist with optimizing patient care in these unprecedented times.
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Purpose : Vision Threatening Diseases (VTDs) (age-related macular degeneration, cataracts, diabetic retinopathy, glaucoma) affect 36 million individuals in the United States. 50% are unaware they have a VTD, disproportionally affecting minorities and lowincome groups with less access to eye care. While screening programs in underserved communities result in early detection, less than half of subjects with findings follow up with a specialist. This number is four times lower during COVID-19. Methods : Robotic Telepresence (RT) was implemented in this pilot study during COVID19 to increase real-time access to specialist care. 58 subjects (age 56, 45% male) underwent a non-mydriatic screening protocol over five screenings. They were divided into three groups for consult: In Person (IP) followed by RT (N = 21), RT followed by IP (N = 19), and IP only (N = 18). IP consult was done by an on-site certified reader. RT consult was done by an off-site glaucoma or retina specialist with access to blood pressure, visual acuity, intraocular pressure, 45° retinal images, and ocular coherence tomography Bscans via cloud-based software. Video connection for RT was established via HIPAAcompliant mobile hotspot. Subject demographics and preferences were collected afterwards via survey. Results : Of 40 RT consults, 26 were second opinion for VTD suspect and 14 were wellness encounters. 24 reported their last eye care visit >3 years ago or never. Following RT consult, 18 subjects received one or multiple VTD diagnosis and 3 with glaucoma were referred for pressure-lowering eye drops. In the group with IP consult first, preferences were 5% RT, 52% IP, and 43% none. In the group with RT consult first, preferences were 5% RT, 58% IP, and 37% none. There was no significant difference in number of questions asked, wait time, or encounter length between IP and RT consults. Conclusions : RT consults proved valuable in community-based VTD screenings, particularly during COVID-19 when access to eye care is further limited. Most subjects preferred IP. However subjects with VTD that face socioeconomic barriers benefit from immediate RT consult and management directives from remote subspecialists. Further studies should incorporate consults from additional specialties (endocrinologists, general practitioners, social workers) and include telehealth CPT code for reimbursement.
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Purpose : The COVID-19 pandemic prompted efforts to encourage social distancing and minimize non-urgent in-person eye care. Here, we report the outcomes of a teleophthalmology program for diabetic retinopathy screening at an integrated health system in California that was expanded during the pandemic. Methods : We performed a retrospective review of patients who underwent remote retinal imaging as part of a teleophthalmology program for diabetic retinopathy (DR) screening using Current Procedural Terminology (CPT) codes 92227 and 92228 at the University of California, Davis Health system between May 31st , 2019 and June 8th , 2021. Retinal images were captured at primary care locations using a Topcon NW400, Nikon RetinaStation, or Optos Primary fundus cameras, and image grading were performed by trained ophthalmologists or optometrists using a store-and-forward method. Patient records were reviewed to collect demographic, follow-up, and clinical outcomes information. Results : During COVID19 pandemic, the teleophthalmology program screened 570 individuals (mean age 63.2 ± 13.7). There was a significant increase in the number of patients screened per month prior to and following the COVID-19 lock-down in March 2020 (5.0 ± 3.1 patients screened per month prior to and 39.1 ± 34.8 patients per month following, P = 0.0004). Among these, 204 patients received a recommendation for in-person eye care referral, of which 127 received a referral to the UC Davis Eye Center, 85 appointments were scheduled, and 82 patients were followed in person, with a median time of 108 days between screening and in-person follow-up. Follow-up rates were generally lower during the initial months after the pandemic and increased over time. Among the patients who followed in person (mean age 63.9 ± 13.8), 10% of eyes had mild non-proliferative DR (NPDR), 5% had moderate NPDR, 3% had severe NPDR, 2% had PDR, and 4% had diabetic macular edema (DME), with similar proportions before and after the COVID-19 lockdown. Conclusions : Expansion of a teleophthalmology program during the COVID19 pandemic demonstrated improved DR screening rates, increased referrals, and improved follow-up for diabetic eye care at an integrated health system in Northern California.
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Purpose : While tele-ophthalmology has existed in various forms as an adjunct tool in screening, diagnosis, and remote management, its adoption as a primary means of eye care delivery has been limited. The COVID-19 pandemic led to limited ability to provide in-person eye care and accelerated the need for tele-ophthalmology. This ongoing study seeks to understand patients' attitudes, motivations, and barriers to the use of tele-ophthalmology in lieu of in-person visits. Methods : From March-October, 2020, in-person visits to a single university-based eye clinic were restricted to urgent ocular complaints. All routine visits were offered as video visits (VV) through the electronic medical record (EMR). 800 patients who completed a VV during this period, as well as a random selection of 800 patients who completed an in-office visit 6 months prior but no VV during this period, were sent an online survey. Data collected included demographic information, use of and comfort with digital devices, knowledge of the VV option, and reasons for use/non-use of the VV option. Results : 35 individuals (54% male, 46% female;80% White, 9% Black, 3% Asian, 9% other;mean age 63 ± 15 years) have participated in the study to date. 15 (43%) did not have a VV and 20 (57%) completed a VV. There were no significant differences in demographic factors between groups. 80% without vs 75% with a VV (p>0.05) felt somewhat or very comfortable using digital devices. 100% without vs 90% (p>0.05) with a VV were registered for the EMR patient portal prior to March 2020. Of the individuals who did not complete a VV, 25% did not want a VV for eye care, 25% were unaware of the VV option, 19% did not feel follow up was needed, 25% felt VV were insufficient for their eye care needs, and 1% reported lack of insurance coverage of VV as reasons for not choosing to complete a VV. Binomial logistic regression showed that demographic factors, comfort with digital device use, and prior access to the patient portal did not influence use/non-use of a VV. Conclusions : The importance of tele-ophthalmology continues to increase as the COVID-19 pandemic threatens to limit feasibility of or patient willingness for in-person visits. An understanding of patients' attitudes towards and barriers to accepting video visits may help minimize disruptions in necessary eye care in case of future limitations in access to in-person services.
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Purpose : Congress passed the CARES Act (Coronavirus Aid, Relief, and Economic Security) Provider Relief Fund to help healthcare providers recoup lost revenue during the pandemic. We aimed to determine how much of this federal aid was provided to ophthalmology and optometry practices, and whether the amount of aid received varied based on practice size. Methods : We used the Centers for Medicare and Medicaid Services (CMS) Physician Compare National Database to identify medical practices that provide eye care. We used practice names to link this database to the Health and Human Services (HHS) Provider Relief Fund (PRF) database to determine how much aid each practice received through the CARES Act. Results : We identified 2,625 optometry or ophthalmology practices that received funding through the CARES Act Provider Relief Fund that were not hospital-owned or affiliated with multi-specialty practices. Large practices with more than 10 clinicians accounted for only 268 of the 2,625 practices in our sample, but received nearly half of all funding ($182 million). Per-practitioner funding varied based on practice size (p=0.047), but differences in per-practitioner funds were not significant after adjusting for practice specialty (ophthalmology, optometry, or both). We also found that retina specific practices tended to receive more than their counterparts. Conclusions : This study demonstrates a relatively uniform distribution of per capita funds when adjusted for ophthalmologists, optometrists, and mixed-practices regardless of practice size. This policy demonstrates how federal aid is distributed to independent ophthalmology practices, and that smaller practices which are at higher risk may need larger per capita payments to remain viable during times of economic stress.
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Purpose : To evaluate the impact of the COVID-19 pandemic on diabetic retinopathy screening (DRS) to uninsured, predominantly Latino patients at the UC San Diego Student-Run Free Clinic Project (SRFCP). Methods : A retrospective analysis of the electronic medical records of all diabetic patients seen in the years 2019, 2020, and 2021 (N = 196, 183, and 178 respectively) at the SRFCP was performed. Ophthalmology specialty clinic metrics from before, during, and after the COVID-19 pandemic-related lockdowns were compared to assess the impact of the COVID-19 pandemic lockdowns on DRS rates. All statistical analyses were performed in Microsoft Excel. Results : In patients with available demographic data (N=164), 92.1% were Latino, 69.5% female, with a mean age of 58.7 years (SD=10.6). A chi-squared test for goodness of fit showed that the distribution of patients seen (p<0.001), referred (p=0.012), or scheduled (p<0.001) in 2020 and 2021 differed significantly when compared to 2019. In 2019, 99 (50.5%) of 196 patients requiring DRS were referred, of which 97 (49.5%) were scheduled, and 89 (45.4%) were seen by the ophthalmology clinic (Figure 1). In 2020, a similar percentage of patients were referred (76/183 patients, or 41.5%), but the number of patients scheduled and seen dropped to 37 (20.2%) and 21 (11.4%), respectively. In 2021, clinic performance recovered with 113 (63.5%) of 178 patients eligible for DRS referred, 100 (56.2%) scheduled, and 82 (46.1%) seen. No-shows and cancellations constituted 12 (12.4%) and 6 (6.2%) of the 97 encounters in 2019. Conversely, of the 37 encounters scheduled in 2020, the no-show (10.8%) and cancellation (40.5%) rates were notably higher. Conclusions : The COVID-19 pandemic significantly diminished the delivery of eye care to patients at the SRFCP. 2020 saw a meaningful decline from 2019 in all clinic performance metrics which was reversed in 2021. These results show the current need for annual DRS surpassed the ability of the ophthalmology specialty clinic to schedule and deliver care to these patients in all years evaluated, especially in 2020 due to COVID-19 restrictions. SRFCP patients may benefit from telemedicine-based DRS programs such as remote imaging during primary care visits to further improve screening capacity. (Figure Presented).
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Purpose : During the COVID-19 pandemic, regulatory changes in the United States allowed physicians to practice telemedicine across state lines. Data on the use of interstate ophthalmic telemedicine during the pandemic are limited. We aimed to evaluate the geographic characteristics and interstate utilization of telemedical care as compared to in-person care at a tertiary eye care center during the pandemic. Methods : In this single-center, retrospective, cross-sectional study at Massachusetts Eye and Ear (MEE) from January 1 to December 31, 2020, clinical encounters were reviewed to extract patient and visit characteristics. In-person versus telemedical visit types were identified based on institutional categories and billing codes. Residential zip codes were used to estimate geographic characteristics of patients including distance from MEE and in-state versus out-of-state status. Pearson chi-squared tests were used to compare telemedical and in-person care groups. Results : A total of 1911 telemedical patients (2262 encounters) and 65763 in-person patients (147211 encounters) were included. The median (interquartile range;IQR) age of telemedicine patients was 61 (43-72) years, 62% of which were female. The median (IQR) age of in-person patients was 63 (49-72) years, 58% of which were female. Telemedicine patients included 14.7% (n=281) out-of-state patients, as compared to 12.0% (n=7876) out-of-state in-person patients (p<0.001). Regarding distance, 42.5% of telemedicine patients and 47.5% of in-person patients lived <10 miles (p<0.001), 41.9% and 41.3% lived 10-50 miles (p=0.611), 8.8% and 7.0% lived 51-100 miles (p=0.002), 3.9% and 2.5% lived 101- 250 miles (p<0.001), and 3.0% and 1.8% lived >250 miles (p<0.001) away from MEE, respectively. Conclusions : A significantly greater proportion of telemedical care, as compared to in-person care, was provided to out-of-state patients at a large eye care center during the pandemic. Moreover, a significantly greater proportion of telemedical care was utilized by patients living further away from the eye center. Proposals to revert to pre-pandemic policies requiring in-state telemedicine could set back forward progress made during the pandemic, including negative impacts on access to care and continuity of care for established patients. Expanded telemedicine licensure and scope could help advance the efficiency and deployment gains seen during the pandemic.
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Introduction: 42% of patients in the intensive care unit (ICU) will suffer ocular damage during their stay.1 Multiple mechanisms that usually protect the eye are inhibited, whilst interventions such as positive airway pressure and muscle relaxants further expose the eye to harm.2 This became increasingly evident during the COVID-19 pandemic, where non-invasive ventilation and proning of patients exposed patients to risk of injury.3 Redeployment of Ophthalmologists to ICU during the first wave of the COVID-19 pandemic highlighted the need for a robust and sustainable intervention to reduce the frequency of eye complications in our unit. Objectives: Our objective was to reduce harm to eyes in all patients within the Royal Infirmary of Edinburgh (RIE) to zero ICU within nine months. Methods: Our QI project involved initial staff and patient data collection regarding current eye care practices. A fish-bone diagram facilitated group discussions with ICU clinical teams regarding prior eye care practices. A pareto chart identified categories to focus on, with a driver diagram identifying change ideas. Our primary intervention was the design and introduction of a bespoke eye care guideline. Specific outcomes, processes, and balancing measures were set out, and multiple PDSA cycles helped to prompt interventions to ensure consistent and standardised care was delivered. Run charts were regularly reviewed and a variety of interventions were introduced throughout the data collection period as tests of change. These included: 1. posters highlighting guideline enrolment 2. formal teaching at handovers and on the unit 3. educational emails to staff members 4. prompts on daily reviews to highlight eye care assessments. Between 28 Sept 2020 -28 June 21, twenty patients in RIE ICU were randomly selected by the data collection team weekly. Patient outcome -eyes were examined and noted if they had developed any ocular complications during their stay. Patients who had evidence of ocular damage on admission were excluded unless they developed further complications. A single episode was not counted twice. Process outcomes -Eye care guideline adherence was recorded, and non-compliance was rectified following data collection. The data was recorded on run charts, accessible via MS teams, allowing all project team members to review the data remotely. Results: During our data collection period, the introduction of our guideline and educational interventions reduced the median number of patients who suffered eye complications in ICU by 50% within nine months (Figure 1). Chemosis and evidence of dry eyes were the most common complications. Since initiation of the guideline, our educational interventions have maintained median guideline compliance at 80%. Conclusion: This is a comprehensive, patient-centred, QI project, utilizing a systematic methodology to introduce a new guideline within ICU. This project has resulted in a sustained improvement of eye care standards, and reduction of eye complications within RIE ICU. This project was ongoing during the second wave of the COVID-19 pandemic, where constant rotation of medical staff, unfamiliar with ICU, required education to ensure guideline compliance was achieved. Our eye care guideline is now part of a multicentre project to standardise care across NHS healthboards.
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Introduction: Ocular complications in critically ill patients is common. Up to 42% of intensive care unit patients can have signs of damage to the corneal surface of the eye (exposure keratopathy), which can lead to secondary complications and ultimately irreversible visual loss1,2 (Rosenberg and Eisen, 2008;Bird et al, 2017). Emergence of COVID-19 pandemic has meant increased number of critical care admission with inherent risk of ocular complication owing to need for non-invasive ventilation, mechanical ventilation and prone ventilation. All these factors have resurfaced need for increased awareness and adherence to national standards related to eye care in critical care3 (Royal college of Ophthalmology and Intensive Care Society joint Ophthalmic service guidance). Objectives: To study baseline knowledge and awareness of eye care practices in neuro critical care unit. To measure compliance of national eye care guidance. Methods: Structured online survey for critical care nurses. Review of hospital IT software to study snapshot of eye care compliance. Results: We ran baseline survey of neuro critical care nurses on knowledge and current practice of eye care in ICU. Eye care complications in ICU are common with 1 in 5 individual reporting > 3 ocular complications in last 3 months. Three-quarter of individuals reported to have good to very good knowledge of eye care protocol with 66% aware of current national guidance. 86% of respondents assessed lagophthalmos while 76% assessed conjunctiva and cornea routinely. On the flipside however only 60% routinely documented eye care measures in clinical practice. Importantly, 96% responded that they would benefit from education and training in eye care practices. Review of hospital records for eye care compliance and documentation validated the findings on the survey. We found 68% compliance rate for assessment of lagophthalmos in all admitted patient in neuro critical care unit. There was 100% compliance to institution of protective measures and appropriate escalation to medical staff. Graph 1: Baseline survey of knowledge and practice of Eye care in Neuro Critical Care Unit depicting a stepladder pattern in knowledge, practice and documentation of Eye care. Conclusion: Knowledge and awareness of eye care practices fall below national guidance. There is clear gap in knowledge, practice and documentation of eye care practices. Incorporation of eye care module in continuous training program and use of cognitive aids may help to further improve compliance and documentation of eye care practice in future.