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1.
JAMA Ophthalmol ; 140(5): 465-471, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1767291

ABSTRACT

Importance: Visual acuity (VA) is one of the most important clinical data points in ophthalmology. However, few options for validated at-home VA assessments are currently available. Objective: To validate 3 at-home visual acuity tests in comparison with in-office visual acuity. Design, Setting, and Participants: Between July 2020 and April 2021, eligible participants with VA of 20/200 or better were recruited from 4 university-based ophthalmology clinics (comprehensive, cornea, glaucoma, and retina clinics). Participants were prospectively randomized to self-administer 2 of 3 at-home VA tests (printed chart, mobile phone app, and website) within 3 days before their standard-of-care clinic visit. Participants completed a survey assessing usability of the at-home tests. At the clinic visit, best-corrected Snellen distance acuity was measured as the reference standard. Main Outcomes and Measures: The at-home VA test results were compared with the in-office VA test results using paired and unpaired t tests, Pearson correlation coefficients, analysis of variance, χ2 tests, and Cohen κ agreement. The sensitivity, specificity, positive predictive value, and negative predictive value of each at-home test were calculated to detect significant VA changes (≥0.2 logMAR) from the in-office baseline. Results: A total of 121 participants with a mean (SD) age of 63.8 (13.0) years completed the study. The mean in-office VA was 0.11 logMAR (Snellen equivalent 20/25) with similar numbers of participants from the 4 clinics. Mean difference (logMAR) between the at-home test and in-office acuity was -0.07 (95% CI, -0.10 to -0.04) for the printed chart, -0.12 (95% CI, -0.15 to -0.09) for the mobile phone app, and -0.13 (95% CI, -0.16 to -0.10) for the website test. The Pearson correlation coefficient for the printed chart was 0.72 (95% CI, 0.62-0.79), mobile phone app was 0.58 (95% CI, 0.46-0.69), and website test was 0.64 (95% CI, 0.53-0.73). Conclusions and Relevance: The 3 at-home VA test results (printed chart, mobile phone app, and website) appeared comparable within 1 line to in-office VA measurements. Older participants were more likely to have limited access to digital tools. Further development and validation of at-home VA testing modalities is needed with the expansion of teleophthalmology care.


Subject(s)
COVID-19 , Ophthalmology , Telemedicine , COVID-19/epidemiology , Humans , Middle Aged , Ophthalmology/methods , Telemedicine/methods , Vision Tests/methods , Visual Acuity
2.
BMJ Open ; 12(2): e055845, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1673442

ABSTRACT

INTRODUCTION: Recent years have witnessed an upsurge of demand in eye care services in the UK. With a large proportion of patients referred to Hospital Eye Services (HES) for diagnostics and disease management, the referral process results in unnecessary referrals from erroneous diagnoses and delays in access to appropriate treatment. A potential solution is a teleophthalmology digital referral pathway linking community optometry and HES. METHODS AND ANALYSIS: The HERMES study (Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease: a cluster randomised superiority trial with a linked diagnostic accuracy study) is a cluster randomised clinical trial for evaluating the effectiveness of a teleophthalmology referral pathway between community optometry and HES for retinal diseases. Nested within HERMES is a diagnostic accuracy study, which assesses the accuracy of an artificial intelligence (AI) decision support system (DSS) for automated diagnosis and referral recommendation. A postimplementation, observational substudy, a within-trial economic evaluation and discrete choice experiment will assess the feasibility of implementation of both digital technologies within a real-life setting. Patients with a suspicion of retinal disease, undergoing eye examination and optical coherence tomography (OCT) scans, will be recruited across 24 optometry practices in the UK. Optometry practices will be randomised to standard care or teleophthalmology. The primary outcome is the proportion of false-positive referrals (unnecessary HES visits) in the current referral pathway compared with the teleophthalmology referral pathway. OCT scans will be interpreted by the AI DSS, which provides a diagnosis and referral decision and the primary outcome for the AI diagnostic study is diagnostic accuracy of the referral decision made by the Moorfields-DeepMind AI system. Secondary outcomes relate to inappropriate referral rate, cost-effectiveness analyses and human-computer interaction (HCI) analyses. ETHICS AND DISSEMINATION: Ethical approval was obtained from the London-Bromley Research Ethics Committee (REC 20/LO/1299). Findings will be reported through academic journals in ophthalmology, health services research and HCI. TRIAL REGISTRATION NUMBER: ISRCTN18106677 (protocol V.1.1).


Subject(s)
Ophthalmology , Optometry , Retinal Diseases , Telemedicine , Artificial Intelligence , Humans , Ophthalmology/methods , Randomized Controlled Trials as Topic , Referral and Consultation , Retinal Diseases/diagnosis , Telemedicine/methods
3.
JAMA Ophthalmol ; 139(11): 1174-1182, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1432343

ABSTRACT

Importance: Telemedicine has been shown to have had reduced uptake among historically marginalized populations within multiple medical specialties during the COVID-19 pandemic. An evaluation of health disparities among patients receiving ophthalmic telemedical care during the pandemic is needed. Objective: To evaluate disparities in the delivery of ophthalmic telemedicine at Massachusetts Eye and Ear (MEE) during the COVID-19 pandemic. Design, Setting, and Participants: This retrospective, cross-sectional study analyzed clinical visits at a single tertiary eye care center (MEE) from January 1 to December 31, 2020. Patients who had ophthalmology and optometry clinical visits at the MEE during the study period were included. Exposures: Telemedicine vs in-person clinical encounters. Main Outcomes and Measures: Variables associated with use of ophthalmic telemedicine during the study period. Results: A total of 2262 telemedicine ophthalmic encounters for 1911 patients were included in the analysis. The median age of the patients was 61 (interquartile range, 43-72) years, and 1179 (61.70%) were women. With regard to race and ethnicity, 87 patients (4.55%) identified as Asian; 128 (6.70%), as Black or African American; 23 (1.20%), as Hispanic or Latino; and 1455 (76.14%), as White. On multivariate analysis, factors associated with decreased receipt of telemedical care included male sex (odds ratio [OR], 0.86; 95% CI, 0.77-0.96), Black race (OR, 0.69; 95% CI, 0.56-0.86), not speaking English (OR, 0.63; 95% CI, 0.48-0.81), educational level of high school or less (OR, 0.83; 95% CI, 0.71-0.97), and age (OR per year of age, 0.99; 95% CI, 0.989-0.998). When comparing telephone- and video-based telemedicine visits, decreased participation in video-based visits was associated with age (OR per year of age, 0.96; 95% CI, 0.94-0.98), educational level of high school or less (OR, 0.54; 95% CI, 0.29-0.99), being unemployed (OR, 0.28; 95% CI, 0.12-0.68), being retired (OR, 0.22; 95% CI, 0.10-0.42), or having a disability (OR, 0.09; 95% CI, 0.04-0.23). Conclusions and Relevance: The findings of this cross-sectional study, though limited to retrospective data from a single university-based practice, suggest that historically marginalized populations were less likely to receive ophthalmic telemedical care compared with in-person care during the first year of the COVID-19 pandemic in the US. Understanding the causes of these disparities might help those who need access to virtual care.


Subject(s)
COVID-19/prevention & control , Ophthalmology/methods , Telemedicine/statistics & numerical data , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Eye Diseases , Female , Humans , Infant , Male , Middle Aged , Ophthalmology/trends , Pandemics , Retrospective Studies , SARS-CoV-2
4.
Ophthalmologe ; 119(4): 374-380, 2022 Apr.
Article in German | MEDLINE | ID: covidwho-1427244

ABSTRACT

BACKGROUND: The COVID-19 pandemic in 2020 and 2021 severely restricted the care of ophthalmology patients. Teleophthalmological services, such as video consultation or medical telephone advice could, at least partially, compensate for the lack of necessary controls in the case of chronic diseases; however, teleophthalmological options are currently still significantly underrepresented in Germany. OBJECTIVE: In order to determine the willingness of patients to use telemedicine and the virtual clinic, we conducted a survey using a questionnaire on the subject of teleophthalmology in university medicine patients with known glaucoma as a chronic disease during the first wave of the COVID-19 pandemic. METHODS: A total of100 patients were interviewed. The questionnaire contained 22 questions with multiple choice possible answers. The inclusion criterion was the presence of glaucoma as a chronic disease, age over 18 years, and sufficient linguistic understanding to answer the questions. The data were collected, analyzed and anonymously evaluated. RESULTS: In the patient survey it could be shown that the respondents with glaucoma are very willing to do teleophthalmology and that this would be utilized. Of the patients surveyed 74.0% would accept telemedicine and virtual clinics. Of the ophthalmological patients surveyed 54.0% stated that their visit to the doctor/clinic could not take place due to SARS-CoV­2 and 17.0% of the patients stated that the SARS-CoV­2 pandemic had changed their opinion of telemedicine. DISCUSSION: The acceptance of telemedicine in patients with chronic open-angle glaucoma seems surprisingly high. This has been increased even further by the SARS-CoV­2 pandemic. These results reflect a general willingness of patients with chronic eye disease but do not reflect the applicability and acceptance and applicability from a medical point of view; however, this form of virtual consultation is accepted by the majority of patients with glaucoma and could be considered for certain clinical pictures.


Subject(s)
COVID-19 , Glaucoma, Open-Angle , Glaucoma , Ophthalmology , Telemedicine , Adolescent , Glaucoma/diagnosis , Glaucoma/epidemiology , Glaucoma/therapy , Humans , Ophthalmology/methods , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
5.
PLoS One ; 16(9): e0257250, 2021.
Article in English | MEDLINE | ID: covidwho-1403322

ABSTRACT

BACKGROUND: Due to the many restrictions imposed during the COVID-19 emergency, the normal clinical activities have been stopped abruptly in view of limiting the circulation of the virus. The extraordinary containment measures have had a dramatic impact on the undertaking and follow-up of ophthalmic outpatients. OBJECTIVE: In order to guarantee proper monitoring and routine care, the Pediatric Ophthalmology equipe of Rovereto Hospital (North-East of Italy) supported by the Competence Center on Digital Health TrentinoSalute4.0, designed and implemented a digital platform, TreC Oculistica, enabling teleophthalmology. We report our innovative-albeit restricted-experience aiming at testing and maximizing the efficacy of remote ophthalmic and orthoptic visits. METHODS: A multidisciplinary team created the TreC Oculistica platform and defined a teleophthalmology protocol. The system consists of a clinician web interface and a patient mobile application. Clinicians can prescribe outpatients with the App and some preliminary measurements to be self-collected before the televisit. The App conveys the clinician's requests (i.e. measurements) and eases the share of the collected information in a secure digital environment, promoting a new health care workflow. RESULTS: Four clinicians took part in the testing phase (2 ophthalmologists and 2 orthoptists) and recruited 37 patients (mostly pediatric) in 3 months. Thanks to a continuous feedback between the testing and the technical implementation, it has been possible to identify pros and cons of the implemented functionalities, considering possible improvements. Digital solutions such as TreC Oculistica advance the digitalization of the Italian health care system, promoting a structured and effective reorganization of the workload supported by digital systems. CONCLUSIONS: The study tested an innovative digital solution in the teleophthalmology context and represented the first experience within the Italian healthcare system. This solution opens up new possibilities and scenarios that can be effective not only during the pandemic, but also in the traditional management of public health services.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/methods , Mobile Applications , Ophthalmology/methods , Pandemics , Telemedicine/methods , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Italy/epidemiology , Male , Young Adult
6.
J Neuroophthalmol ; 41(3): 356-361, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1367102

ABSTRACT

BACKGROUND: The novel coronavirus 2019 (COVID-19) pandemic has transformed health care. With the need to limit COVID-19 exposures, telemedicine has become an increasingly important format for clinical care. Compared with other fields, neuro-ophthalmology faces unique challenges, given its dependence on physical examination signs that are difficult to elicit outside the office setting. As such, it is imperative to understand both patient and provider experiences to continue to adapt the technology and tailor its application. The purpose of this study is to analyze both neuro-ophthalmology physician and patient satisfaction with virtual health visits during the time of the COVID-19 pandemic. METHODS: Across three institutions (NYU Langone Health, Indiana University Health, and Columbia University Medical Center), telemedicine surveys were administered to 159 patients. Neuro-ophthalmologists completed 157 surveys; each of these were linked to a single patient visit. Patient surveys consisted of 5 questions regarding visit preparation, satisfaction, challenges, and comfort. The physician survey included 4 questions that focused on ability to gather specific clinical information by history and examination. RESULTS: Among 159 patients, 104 (65.4%) reported that they were satisfied with the visit, and 149 (93.7%) indicated that they were comfortable asking questions. Sixty-eight (73.9%) patients found the instructions provided before the visit easy to understand. Potential areas for improvement noted by patients included more detailed preparation instructions and better technology (phone positioning, Internet connection, and software). More than 87% (137/157) of neuro-ophthalmologists surveyed reported having performed an examination that provided enough information for medical decision-making. Some areas of the neuro-ophthalmologic examination were reported to be easy to conduct (range of eye movements, visual acuity, Amsler grids, Ishihara color plates, and pupillary examination). Other components were more difficult (saccades, red desaturation, visual fields, convergence, oscillations, ocular alignment, and smooth pursuit); some were especially challenging (vestibulo-ocular reflex [VOR], VOR suppression, and optokinetic nystagmus). Clinicians noted that virtual health visits were limited by patient preparation, inability to perform certain parts of the examination (funduscopy and pupils), and technological issues. CONCLUSIONS: Among virtual neuro-ophthalmology visits evaluated, most offer patients with appointments that satisfy their needs. Most physicians in this cohort obtained adequate clinical information for decision-making. Even better technology and instructions may help improve aspects of virtual health visits.


Subject(s)
COVID-19/epidemiology , Eye Diseases/diagnosis , Ophthalmology/methods , Pandemics , Physicians/statistics & numerical data , Surveys and Questionnaires , Telemedicine/methods , Comorbidity , Eye Diseases/epidemiology , Humans , Retrospective Studies
8.
Clin Exp Optom ; 104(6): 711-716, 2021 08.
Article in English | MEDLINE | ID: covidwho-1238095

ABSTRACT

CLINICAL RELEVANCE: Following the COVID-19 lockdown, uptake of slitlamp-enabled live teleophthalmology increased. Its use contributed to a reduction of referrals escalated to secondary care during-lockdown (avoided: 64% pre-lockdown vs 86% during-lockdown). BACKGROUND: Live teleophthalmology using video conferencing allows real-time, three-way consultation between secondary care, community providers and patients, improving interpretation of slit lamp findings and potentially reducing referrals to secondary care. NHS Forth Valley implemented live teleophthalmology in March 2019. In March 2020, the COVID-19 pandemic created urgency to deliver ophthalmic care while minimising the risk of contracting or spreading the disease. We aim to compare the uptake and two outcomes (number of avoided secondary care referrals; pattern of presenting conditions) of live teleophthalmology consultations in NHS Forth Valley before and during the COVID-19 national lockdown. METHODS: An NHS secure video conferencing platform connected the video slit lamps of optometrists, or an iPad mounted on a slit lamp and viewing through the eyepieces, to a secondary care ophthalmologist via a virtual live clinic/waiting area. Data about avoiding a secondary care referral were extracted from a post-consultation ophthalmologist survey for 14 months of data. Pre- and during-lockdown intervals were before/after 23 March 2020, when routine eyecare appointments were suspended. Numbers of avoided referrals to secondary care and patterns of presenting conditions were compared for pre- and during-lockdown periods. RESULTS: The COVID-19 pandemic markedly increased use of live teleophthalmology in NHS Forth Valley. Surveys were completed for 164 of 250 (66%) teleophthalmology consultations over the study period. Data from 154 surveys were analysed, 78 and 76 for the pre- and during-lockdown periods, respectively. Significantly more during-lockdown (86%) than pre-lockdown (64%; difference 21%, 95% CI 8-34%, p = 0.001) surveys indicated that referrals to secondary care were avoided. CONCLUSION: Survey data from ophthalmologists suggest significantly fewer escalations to secondary care due to teleophthalmology use.


Subject(s)
COVID-19/epidemiology , Eye Diseases/epidemiology , Ophthalmology/methods , Quarantine , Referral and Consultation/trends , Secondary Care/standards , Telemedicine/methods , Communicable Disease Control/methods , Eye Diseases/therapy , Humans , Pandemics , SARS-CoV-2
10.
Am J Ophthalmol ; 230: 234-242, 2021 10.
Article in English | MEDLINE | ID: covidwho-1210782

ABSTRACT

PURPOSE: To assess the initial utilization, safety, and patient experience with tele-ophthalmology during the COVID-19 pandemic. DESIGN: Cross-sectional study. METHODS: We conducted a telephone survey and interview of a random sample of patients who received different modalities of care (in-person, telephone, videocall, or visits deferred) during Michigan's shelter-in-place order beginning March 23, 2020. The survey assessed patient safety, patient satisfaction with care, perceptions of telehealth-based eye care, and worry about eyesight. Data were analyzed via frequency measures (eg, means and standard deviations), χ2 tests, ANOVA, and paired t tests. Interviews were analyzed using grounded theory. RESULTS: A total of 3,274 patients were called and 1,720 (53%) agreed to participate. In-person participants were significantly older than telephone (P = .002) and videocall visit (P = .001) participants. Significantly more white participants had in-person visits than minority participants (P = .002). In-person visit participants worried about their eyesight more (2.7, standard deviation [SD] = 1.2) than those who had telephone (2.5, SD = 1.3), videocall (2.4, SD = 1.1), or deferred visits (2.4, SD = 1.2) (P = .004). Of all telephone or videocall visits, 1.5% (n = 26) resulted in an in-person visit within 1 day, 2.9% (n = 48) within 2-7 days, and 2.4% (n = 40) within 8-14 days after the virtual visit demonstrating appropriate triage to telemedicine-based care. Patients frequently cited a desire for augmenting the telephone or videocall visits with objective test data. CONCLUSIONS: When appropriately triaged, tele-ophthalmology appears to be a safe way to reduce the volume of in-person visits to promote social distancing in the clinic. A hybrid model of eye care combining ancillary testing with a video or phone visit represents a promising model of care.


Subject(s)
COVID-19/prevention & control , Eye Diseases , Health Care Surveys , Ophthalmology/methods , Telemedicine/statistics & numerical data , Adult , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Eye Diseases/diagnosis , Eye Diseases/therapy , Female , Health Services Accessibility/trends , Humans , Male , Middle Aged , Pandemics , Patient Outcome Assessment , Patient Satisfaction , SARS-CoV-2 , Telemedicine/methods
11.
Eur Rev Med Pharmacol Sci ; 25(6): 2726-2729, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1173123

ABSTRACT

This short communication described the actions taken in ophthalmic practice in Kabul, Afghanistan during the COVID-19 pandemic to effectively protect both patients and staff. By following World Health Organisation (WHO), international and local guidelines it has been possible to continue treating ophthalmic outpatients with minimum risk to both patients and staff. The changes which have been implemented may allow better overall infection control in the hospital which will continue to have benefits post-pandemic.


Subject(s)
COVID-19/epidemiology , Eye Diseases/therapy , Infection Control/methods , Ophthalmology/methods , Personal Protective Equipment/supply & distribution , Afghanistan/epidemiology , COVID-19/transmission , COVID-19/virology , Eye Diseases/virology , Humans , Infection Control/statistics & numerical data , Ophthalmology/standards , Practice Guidelines as Topic , SARS-CoV-2/isolation & purification
13.
Surv Ophthalmol ; 66(6): 999-1008, 2021.
Article in English | MEDLINE | ID: covidwho-1164513

ABSTRACT

We review the use of telemedicine in glaucoma and its possible roles in the COVID-19 outbreak. We performed a literature search of published human studies on teleglaucoma on May 12, 2020, using search terms including "telemedicine" and "glaucoma" that were in English and published over the prior 10 years. This search strategy yielded a total of 14 relevant articles after manual curation. Of the 14 articles, 4 were from the same randomized control trial, 7 were prospective studies, 2 were retrospective studies, 1 was descriptive analysis, and 1 was cost-effective analysis. Seven discussed the common ophthalmologic measurements used in teleglaucoma. Four demonstrated the cost effectiveness of the use of teleglaucoma, and 3 articles investigated patient satisfaction with the use of teleglaucoma. Three articles investigated the correlation between teleglaucoma and face-to-face clinics. Five articles discussed the current use and opportunities of teleglaucoma. When compared to in-person care, teleglaucoma is more time and cost-effective, shows high patient satisfaction and fair to good agreement with in-person care; however, there is great variation in the reported sensitivity of glaucoma screening, warranting further studies to establish its efficacy. For glaucoma management, both the sensitivity and specificity must be further improved before it could be put into extensive use. Nevertheless, it is worthwhile to explore the possible extensive application of teleglaucoma in monitoring "glaucoma suspects" and maintaining glaucoma follow-up during a pandemic outbreak to reduce the risk of transmission of infection.


Subject(s)
COVID-19/epidemiology , Disease Outbreaks , Glaucoma/diagnosis , Ophthalmology/organization & administration , SARS-CoV-2 , Telemedicine/organization & administration , Delivery of Health Care , Health Services Accessibility , Humans , Ocular Hypertension/diagnosis , Ophthalmology/methods , Prospective Studies , Remote Consultation/methods , Retrospective Studies , Telemedicine/methods
14.
Semin Ophthalmol ; 36(4): 296-303, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1147415

ABSTRACT

Spurred by the coronavirus disease pandemic and shortage of eye care providers, telemedicine is transforming the way ophthalmologists care for their patients. Video conferencing, ophthalmic imaging, hybrid visits, intraocular inflammation quantification, and portable technology are evolving areas that may allow more uveitis patients to be evaluated via telemedicine. Despite these promising disruptive technologies, there remain significant technological limitations, legal barriers, variable insurance coverage for virtual visits, and lack of clinical trials for uveitis specialists to embrace telemedicine.


Subject(s)
COVID-19/epidemiology , Ophthalmology/methods , SARS-CoV-2 , Specialization/trends , Telemedicine/methods , Uveitis/diagnosis , Uveitis/therapy , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Humans
15.
BMC Ophthalmol ; 21(1): 139, 2021 Mar 20.
Article in English | MEDLINE | ID: covidwho-1143189

ABSTRACT

BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face-to-face encounters to only patients with urgent and emergent ophthalmic conditions in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the 6 weeks before and after the changes in clinical practice associated with COVID-19. RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.


Subject(s)
Academic Medical Centers/trends , Ambulatory Care/trends , COVID-19/epidemiology , Eye Diseases/diagnosis , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Ophthalmology/trends , Practice Patterns, Physicians'/trends , SARS-CoV-2 , COVID-19/transmission , Communicable Disease Control , Humans , International Classification of Diseases , Ophthalmology/methods , Practice Guidelines as Topic , Retrospective Studies , Telemedicine/methods , United States
17.
J Coll Physicians Surg Pak ; 30(1): S32-S34, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1112946

ABSTRACT

Ophthalmology is a specialty which involves close contact with patients. Personal protective equipment (PPE) along with modifications in examination techniques and equipment are needed to avoid spread of coronavirus infectious disease (COVID-19) to health professionals. This communication aims to highlight and critically analyse the measures suggested to control this spread. We also highlighted our experience with protective gear modifications. As with any practice, triage is cornerstone. Use of disinfectants, good personal hygiene practices and PPE for patients and staff, must be adopted for safe ophthalmology practices. Key Words: COVID-19, Ophthalmology, Personal protective equipment (PPE).


Subject(s)
COVID-19/epidemiology , Eye Diseases/epidemiology , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Ophthalmology/methods , Pandemics , Personal Protective Equipment , COVID-19/transmission , Comorbidity , Humans , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data
18.
Semin Ophthalmol ; 36(4): 258-263, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1112057

ABSTRACT

INTRODUCTION: Telemedicine in ophthalmology, and specifically in retinal diseases, has made significant advancements in recent years. The COVID-19 pandemic has launched telehealth into a new era by creating demand from patients and physicians alike, while breaking down previous insurance, reimbursement, access and educational barriers. METHODS: This paper reviews mulitple studies demonstrating the use of telemedicine in managing various retinal conditions before and during the COVID-19 pandemic. CONCLUSION: Moving forward, promising new devices and models of care ensure that tele-retinal care will continue to expand and become a vital part of how we screen, diagnose and monitor retinal diseases.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/trends , Ophthalmology/methods , Retinal Diseases/diagnosis , Retinal Diseases/therapy , SARS-CoV-2 , Telemedicine/methods , Health Services Accessibility , Humans
19.
Semin Ophthalmol ; 36(7): 461-468, 2021 Oct 03.
Article in English | MEDLINE | ID: covidwho-1109026

ABSTRACT

Purpose: To examine the uptake, results, and patient assessment of virtual inpatient ophthalmology consultations at our academic medical center during the COVID-19 pandemic.Design: Retrospective review, pre and post COVID analysis, and teleophthalmology patient survey in the inpatient and emergency setting.Participants: Adult patients at our medical center for whom ophthalmology consultation was requested from February 24 through April 19, 2020.Methods: Patient encounters were retrieved and coded for all inpatient and emergency room ophthalmology consultations over a 4-week period before and a 4-week period after our department first offered virtual ophthalmology consultations. Theseconsultations took place over real-time video, audio, or photography between the on-call ophthalmologist and the patient and/or patient's primary physician. A four-item questionnaire was offered to patients who completed a virtual consultation.Main Outcome Measures: Virtual consultation diagnoses and management outcomes; patient assessment of virtual inpatient and emergent ophthalmic care.Results: Of all 423 included encounters, 258 (61%) occurred during the 4 weeks before offering virtual consultations and 165 (39%) encounters occurred during the subsequent 4-week period, indicating a 36% decrease in ophthalmology consultations over this pandemic period. A total of 120 (28%) encounters were conducted remotely during the 8-week period. In-person emergency department (ED) encounters (as percent of total encounters) decreased from 60% to 36% (p < .01) between the first and eighth weeks of the study period. In the 4 weeks since their implementation, virtual inpatient ophthalmology consultations were utilized in 34 of 165 (21%) consultations. Of those, 20 (59%) were high acuity and 1 (3%) was escalated to the ED for in-person evaluation. Most common management decisions made included medication prescription in 46 (55%) patients and scheduling follow-up for 44 (30%) patients. In a survey administered to all 120 patients who were managed over phone or video, 56 (47%) responded. Respondents were in general agreement (Cronbach's alpha = 0.92) and expressed satisfaction with phone and virtual encounters. Specifically, 42 (49%) of 86 patients who had phone encounters noted a mean weighted satisfaction score of 4.6 out of 5 and 14 (41%) responders of 34 virtual consultation encounters noted a mean weighted satisfaction score of 4.9 out of 5. The difference between the average weighted satisfaction scores favored virtual consultation over telephone encounters (p < .01).Conclusions: Virtual inpatient ophthalmology consultations are feasible and have reported high patient satisfaction. Implementing video-based technologies to deliver high-acuity ophthalmic triage and management may help to promote patient and provider safety. In our experience, patients favored virtual consultation over telephone encounters.


Subject(s)
COVID-19/epidemiology , Eye Diseases/diagnosis , Inpatients , Ophthalmology/methods , Patient Satisfaction , Referral and Consultation/organization & administration , Telemedicine/methods , Comorbidity , Emergency Service, Hospital/statistics & numerical data , Eye Diseases/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
20.
Indian J Ophthalmol ; 69(3): 714-718, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1089036

ABSTRACT

PURPOSE: The aim of this study was to describe the experience of teleconsultations addressed at our hospital in India during the ongoing coronavirus (COVID-19) lockdown. METHODS: This cross-sectional hospital-based study included 977 teleconsultations presenting between April 1st and May 31, 2020. A two-level protocol was implemented to triage the calls. RESULTS: Overall, 977 teleconsultation were addressed. Of the 621 teleconsultation addressed the most common queries were related to redness/pain/ watering/blurred vision/itching/irritation (52.49%), followed by queries related to medications (28.01%), appointments (18.84%) & 0.64% cited an emergency need to visit the hospital due to sudden loss of vision. The majority of the queries were directed to the department of cornea (58.93%) followed by retina (16.26%), cataract (13.04%), glaucoma (10.14%) & pediatric ophthalmology (1.61%). The most common advice given to the patient was related to medications (47.66%) followed by appointment-related queries (31.72%) & fixing of surgical appointment (20.61%). Among the 356 preterm babies that were screened, 57 (16.01%) were diagnosed with retinopathy of prematurity (ROP). Of them 3 required laser and 3 were given injection. CONCLUSION: Teleconsultation is here to stay beyond the pandemic. WhatsApp was the preferred modality of communication for us. Teleophthalmology has given us insights to use this evolving technology to reach out to the population at large to provide eye care services. We believe that this mode of teleophthalmology has helped us in providing feasible eye care to the patients.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/methods , Ophthalmology/methods , Quarantine , Telemedicine/methods , Tertiary Care Centers/statistics & numerical data , Vision Disorders/epidemiology , Comorbidity , Cross-Sectional Studies , Delivery of Health Care/methods , Humans , India/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
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