Teleophthalmology research: Where do we stand?

PURPOSE: To identify global research trends in teleophthalmology, as well as productivity and its association with Human development index (HDI). METHODS: A cross-sectional study. The main outcome measures were publication count, citation count, and publications count per million populations. Bibliographic data were derived from the Web of Science website. HDI data were derived from Human Development Report [2020]. One-way ANOVA test was used to examine the association between HDI and the outcome measures. We studied the correlation between continuous variables using Spearman's. Bibliometric analysis software's VOSviewer and Citspace were used to analyse results and creating visualizing maps. RESULTS: The results retrieved 355 publications, one-third of them have been published in the year of the COVID-19 pandemic; (2020). The USA has contributed to one-half of all publications, and just five countries have contributed to about 90% of all records. Very high HDI countries had significantly more publications count per million populations, than high (p-value = 0.0047), medium (p-value = 0.0081) or low HDI countries (p-value = 0.002). The main themes are screening programmes, reliability, photography, COVID-19, access, artificial intelligence, and cost-effectiveness. The leading countries in terms of both publications and citation count are the USA and India. In terms of publications count per million populations, the leading countries are Singapore and Australia. CONCLUSION: Most of the contribution in teleophthalmology research was confined to a small number of countries. More effort is needed to expand the global contribution. The hotspots in this field are artificial intelligence applications and COVID-19 impact.

Telephone-based consultation in an acute eye clinic service: A patient satisfaction survey.

OBJECTIVES: The coronavirus pandemic has forced healthcare staff across all medical specialties to adapt new and different ways of working. A new approach has been set up in the Acute Referral Clinic (ARC) at Musgrove Park Hospital and a survey has been conducted to measure the impact of the new method on patient and healthcare professionals' satisfaction with the new service. METHODS: A telephone-based consultation was introduced in ARC at Musgrove Park Hospital in March 2020 and patients were instructed to fill out a questionnaire containing eight items using a Likert Scale 1 ('very poor/disagree') to 4 ('very good/strongly agree') plus two boxes for open positive and negative comments respectively. Likewise a questionnaire was designed in order to assess the healthcare professionals' satisfaction using the new approach. Data collection took place over a two month period between the end of March 2020 and end of May 2020. The data underwent quality control and was analysed using descriptive statistics. RESULTS: Patient responses illustrated high satisfaction scores with an overall rating of very good (89.4%). The healthcare professionals' rating of the service was good (28.6% - 'very good/strongly agree', 57.1% - 'good/agree'). The safety rating of the new approach was overall rated 'very good' with 90.4% and 71.4% of patients and healthcare professionals respectively. CONCLUSIONS: The telephone consultations introduced in the wake of COVID-19 are well accepted by both patients and doctors. There are some limitations of the approach, foremost being consultation time and clinic space but these do not outweigh the general benefit of this format amidst a pandemic setting.

Ocular surface assessment in times of sanitary crisis: What lessons and solutions for the present and the future?

PURPOSE: To describe the immediate consequences of SARS-CoV-2 and the COVID-19 pandemic on the ocular surface and eye-care professionals, and to discuss the need for a mandatory switch from currently performed tele-screening to true teleconsultation for remote ocular surface assessment. MAIN FINDINGS: Ophthalmologists have been largely impacted by the COVID-19 sanitary crisis, due to both the ocular manifestations of SARS-CoV-2 and to the high contagiousness of the virus. The proximity of ophthalmologists to their patients have pushed eye-care providers to readapt their practices and develop alternatives to face-to-face consultations. However, teleconsultation has some major limitations and drawbacks, especially for ocular surface assessment that relies on high-quality graphic data for adequate diagnosis. Tele-screening, on the other hand, emphasizes on the importance of history-taking and listening to the patient in order to adequately prioritize appointments based on the presumed degree of emergency. CONCLUSION: Despite all the enthusiasm, tele-screening as currently performed with the available tools is still not capable of completely replacing a standard ophthalmic examination for the assessment of ocular surface diseases. While waiting for new emerging technologies and future implementation of imaging modalities and artificial intelligence, decision making algorithms can help eye-practitioners remotely screen their patients to assess the optimal time for follow-up appointments.

Implementing the new normal in ophthalmology care beyond COVID-19.

The COVID-19 pandemic has altered the clinical landscape immeasurably. The need to physical distance requires rethinking how we deliver ophthalmic care. Within healthcare, we will need to focus our resources on the five T's: Utilising technology, multidisciplinary clinical teams with wide professional talents need to work efficiently to reduce patient contact time. With regular testing, this will allow us to reduce the risk further. We also must acknowledge the explosion of different modalities to train our future ophthalmologists and the global challenges and advantages that these bring. Finally, we must not forget the psychological impact that this pandemic will have on ophthalmologists and ancillary staff, and need to have robust mechanisms for support.

Ophthalmology and SARS-CoV-2: Blind toward those who fight blindness?

SARS-CoV-2 infection recently reached pandemic proportions, with high risk of death for the worldwide population. In this dramatic scenario, all the resources are addressed to the intensive care units for the assessment of the emergency. However, more attention should be paid with respect to the risk of viral diffusion among asymptomatic people. Italy is the second most involved country in the world, and we needed to gain a lot of experience in a very limited time. At least 1 m of distance among people is recommended; however, some clinical practices cannot allow this distance. In this context, we believe that the careful safety assessment of clinical settings, like ophthalmologic ones, may have a remarkable impact on the fight against SARS-CoV-2 spread.