Developing a pediatric ophthalmology telemedicine program in the COVID-19 crisis.

PURPOSE: To describe our methodology for implementing synchronous telemedicine during the 2019 novel coronavirus (COVID-19) pandemic. METHODS: A retrospective review of outpatient records at a single children's hospital from March 21 to April 10, 2020, was carried out to determine the outcome of already-scheduled face-to-face outpatient appointments. The week leading up to the March 21, all appointments in the study period were categorized as follows: (1) requiring an in-person visit, (2) face-to-face visit that could be postponed, and (3) consultation required but could be virtual. Teams of administrators, schedulers, and ophthalmic technicians used defined scripts and standardized emails to communicate results of categorization to patients. Flowcharts were devised to schedule and implement telemedicine visits. Informational videos were made accessible on social media to prepare patients for the telemedicine experience. Simultaneously our children's hospital launched a pediatric on-demand e-consult service, the data analytics of which could be used to determine how many visits were eye related. RESULTS: A total of 237 virtual ophthalmology consult visits were offered during the study period: 212 were scheduled, and 206 were completed, of which 43 were with new patients and 163 with returning patients. Following the initial virtual visit, another was required on average in 4 weeks by 21 patients; in-person follow-up was required for 170 patients on average 4.6 months after the initial virtual visit. None needed review within 72 hours. The pediatric on-demand service completed 290 visits, of which 25 had eye complaints. CONCLUSIONS: With proper materials, technology, and staffing, a telemedicine strategy based on three patient categories can be rapidly implemented to provide continued patient care during pandemic conditions. In our study cohort, the scheduled clinic e-visits had a low no-show rate (3%), and 8% of the on-demand virtual access for pediatric care was eye related.

Induced Tropia Test and Visual Acuity Testing in Nonverbal Children.

The objective of our study was to compare the Cardiff Acuity Card© test (CAC test) (Kay Pictures Ltd) with the induced tropia test (ITT) in nonverbal children for the detection of monocular vision deficit. This is a retrospective case note review of 34 nonverbal children, aged 12-48 months, attending the pediatric ophthalmology clinic at Children's Hospital of Pittsburgh of UPMC between October 2014 and January 2015. 30/34 were included for analysis. Binocular visual acuity and monocular visual acuity were tested at 50cm in 30 and 17 patients, respectively. At 100cm, binocular visual acuity and monocular visual acuity were tested in 16 and 11 patients, respectively. All 30 children had successful induced tropia testing; 21 had no fixation preference and 9 had a fixation preference. Of those that had no difference on monocular visual acuity, five had a fixation preference at 50cm and three at 100cm. Out of 21 that had no fixation preference, 3 had a monocular visual acuity difference, but of only one line. Our study suggests that to obtain as much information as possible without losing the interest or cooperation of the child, it may be more beneficial to perform the CAC test with both eyes open, followed by ITT, before attempting monocular visual acuity testing with the CAC test. Obtaining visual information using ITT was much more attainable compared to monocular CAC testing. The sensitivity using CAC test to find a visual acuity discrepancy is 40% using ITT as the standard, and the specificity is 63%. If one loses the interest of the child after the ITT, at least some information will have been gleaned rather than none about monocular visual behavior. This provides a more complete, attainable approach to gathering visual information.