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Comprehensive tele-ophthalmology screening in vision threatening diseases during COVID-19
Investigative Ophthalmology and Visual Science ; 62(8), 2021.
Article in English | EMBASE | ID: covidwho-1378869
ABSTRACT

Purpose:

Vision Threatening Diseases (VTD) (age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], and glaucoma) account for 37% of all blindness. Screening and follow-up are crucial in preserving vision. During COVID-19, clinics reduced access, using telemedicine for diagnosis and follow-ups. The efficacy of remote screening and triage in the management of single or multiple VTDs was evaluated.

Methods:

We screened 41 subjects (19-85 years, 37% male, 17% Caucasian) (20 controls, 21 subjects). Demographics, 45-degree retinal photos, ganglion cell complex (GCC), and optic nerve head (ONH) images were collected using a non-contact puff-tonometer, nonmydriatic retinal camera, and an OCTA. Demographics and images were transmitted to two readers (onsite telemedicine screener [TS] and remote ophthalmologist [RO]) for triage. Triage was categorized immediate referral to specialist, follow-up in person via clinic or telemedicine visit, or no follow-up necessary during COVID.

Results:

TS made 19 referrals (46%), 6 in person follow-ups (15%), 15 no follow-ups (37%);RO made 17 referrals (41%), 2 in person follow-ups (5%), 22 no follow-ups (54%). TS identified 12 subjects as possible VTD(s) while RO identified 11 subjects. TS and RO agreed on 8 glaucoma, 7 cataract, 3 DR, and 3 and 2 AMD cases, respectively. Glaucoma was identified using IOPs, retinal fundoscopy, and OCT imaging. Mean intraocular pressures were 12.9 and 15.7 (OD, OS) in glaucoma and 14.2 and 14.0 in controls. Fundoscopy was used for overall retinal health while OCT images were used to analyze GCC, ONH, nerve fiber layer, cup to disc ratio, and anterior chamber angles. AMD and DR were identified by fundoscopy and OCT imaging. 11 of the subjects were known clinic patients;both RO and TS referred all 11 to specialty clinics, matching the in-person clinic management.

Conclusions:

During the COVID pandemic, triaging patients can minimize person-toperson contact and help control the spread of the virus. Both readers agreed on the management and triage of a variety of patients with TS and RO differing only on 2 referrals and 4 in person follow-ups. Telemedicine is a promising alternative to in-person patient care for management and triage of vision threatening diseases. Further enrollment and follow-up are needed to increase robustness.
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Collection: Databases of international organizations Database: EMBASE Language: English Journal: Investigative Ophthalmology and Visual Science Year: 2021 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Language: English Journal: Investigative Ophthalmology and Visual Science Year: 2021 Document Type: Article