Characteristics of Tele-ophthalmology visits at a Large Academic Medical Center during the COVID-19 Pandemic

ABSTRACT

Purpose: To describe the experience of tele-ophthalmology at a large academic medical center during the COVID-19 pandemic. Methods: This is a retrospective review of tele-ophthalmology encounters conducted at the Duke Eye Center between March 13 and July 15 , 2020. Collected data includes patient demographics, mode of communication (video or telephone), visit type (new, routine return, or urgent), diagnoses, prescribed medications, management plan, and follow-up care. Results: Five hundred and ninety-two routine return visits, 75 urgent visits, and 75 new patient visits were conducted over 742 tele-ophthalmology encounters spanning nine ophthalmology sub-specialty services pediatric ophthalmology (224), oculoplastics (118), glaucoma (115), vitreoretina (69), cornea (67), inherited retinal disease (45), comprehensive ophthalmology (37), neuro-ophthalmology (34), and ocular oncology (24). The average patient age was 44.2 years (range, 1 month - 100 years). Figure 1 shows the most common diagnoses addressed. Video was the preferred mode of communication over telephone (439 versus 276 encounters). The show rate was 97.4%. The average time spent with patients was 18.0 minutes. The longest average visits occurred during inherited retinal disease (38.2 minutes) and neuro-ophthalmology (23.2 minutes) encounters. An active management decision was made in 36 of the new patient encounters (47.3%), 51 urgent encounters (70.8%), and 116 routine return encounters (20.2%). Figure 2 shows the top prescribed medication classes by subspecialty. In-person follow-up within 4 weeks was required for 28.0% urgent visits, 12.0% new patients, and 4.2% routine return visits. Conclusions: Tele-ophthalmology was utilized during the COVID-19 pandemic across a wide range of patient ages and ophthalmology sub-specialties. A substantial percentage of virtual encounters led to an active management decision, and the majority of encounters did not require a sooner than scheduled in-person follow-up. More research and follow-up are needed to determine if the accuracy of tele-ophthalmology diagnosis and management matches that of in-person encounters.