Telemedicine In Ophthalmology Research Articles

Demographic and socioeconomic disparities in the hybrid ophthalmology telemedicine model.

As telemedicine use expands, it is important to evaluate demographic and socioeconomic disparities among patients receiving ophthalmic care through new hybrid telemedicine models. To evaluate whether there are demographic and socioeconomic disparities in the delivery of the hybrid telemedicine model. Retrospective, cross-sectional, case-control analysis of patient encounters from April to December 2020. A single, academic, hospital-based eye clinic in Boston, Massachusetts. Electronic medical records of all patient encounters from April to December 2020 were reviewed and categorized into hybrid, virtual-only, and standard in-person visits. Patient-level data for all visits were extracted including age, sex, race/ethnicity, primary language, Area Deprivation Index (ADI), insurance type, and marital status. Visit-level data for all hybrid visits were also extracted from the medical record including the visit dates and patient adherence. Demographics for the cohort of patients with at least one no-show visit were compared with demographics for the cohort of patients who only had completed visits. The primary study outcomes were the differences in demographic characteristics between the hybrid visit show and no-show groups. The secondary outcomes included demographic characteristics of patients who did not complete their hybrid visit versus a time-matched cohort of patients who did not complete their standard in-person visit. Continuous variables for patient characteristics were compared with independent samples t-tests and categorical variables were compared using Pearson chi-square tests. Multivariate logistic regression was used to examine the differences between the cohorts. Variables with missing values other than suppressed ADI values were imputed using multiple imputations by chained equations. Of a total of 1025 patients who were scheduled for a hybrid visit, 145 (14.1%) patients failed to complete their visit. Primary language and insurance were found to be statistically different between patients who completed and did not complete their hybrid visits. More English speakers and fewer Haitian Creole speakers completed their hybrid visits (p = 0.007) while more patients with private insurance and fewer patients with Medicaid completed their hybrid telemedicine visits (p = 0.026). No associations were found between hybrid telemedicine visit adherence and age, sex, race/ethnicity, marital status, or ADI. When the 145 patients who failed to complete their hybrid visits were compared to a time-matched cohort of patients who failed to complete their standard in-person visit, we found that patients who missed hybrid visits were similar to those who missed standard in-person visits except for patients insured by Medicare. These patients were more likely to miss a hybrid visit than a standard in-person visit (Odds Ratio 2.199, 95% confidence interval 1.136-4.259, p = 0.019). No associations were found between patient nonadherence with hybrid telemedicine versus with standard in-person visits based on age, sex, primary language, race/ethnicity, marital status, or ADI. The hybrid telemedicine model was associated with insurance and language-based disparities. Patients with non-English primary language and Medicaid recipients were more likely to miss a hybrid visit than their counterparts. Our findings support developing deliberate interventions to ensure hybrid telemedicine care is delivered equitably to all patients.

Patient Satisfaction with the Hybrid Telemedicine Model for Ophthalmology.

Background: The purpose of this research was to compare patient satisfaction between hybrid ophthalmology telemedicine and standard-of-care in-person visits. A retrospective, cross-sectional, case-control analysis of patient satisfaction based on survey data was used. Methods: Responses to the National Research Council Health Patient Survey were retrieved for randomly sampled hybrid ophthalmology telemedicine and in-person visits between March 11, 2020 and December 31, 2021 at a hospital-based eye clinic in Boston, Massachusetts. The primary outcome was based on the question "How likely would you be to recommend this provider to your family and friends?" (0-10 scale) with a score of 9 or 10 coded as satisfied. Two-sample t-tests, Pearson's chi-square tests, and bivariate logistic regressions were used to compare patient satisfaction scores between the hybrid and in-person cohorts. Demographic data, including age, sex, language, and self-reported race and ethnicity, were used as potential predictors of patient satisfaction in a multivariable logistic regression model. Results: There were 49 surveys from hybrid visits and 3,390 surveys from in-person visits. Hybrid visit patients reported high satisfaction scores without significant differences compared to in-person visit patients (hybrid 79% satisfied, in-person 82% satisfied, p = 0.728). Age was significantly associated with satisfaction in the hybrid cohort with the 65+ age group reporting lower satisfaction (below 65 years 100% satisfied, 65+ years 60% satisfied, p = 0.003). No association with age was observed in the in-person cohort. Conclusions: The hybrid ophthalmology telemedicine model can provide effective care without sacrificing patient satisfaction. Older patients may benefit from targeted interventions in future telemedicine models.

Telemedicine in Ophthalmology: Lessons from the COVID-19 Era and Beyond

Abstract The progress of information and communication technologies in the era of COVID-19 created an unprecedented opportunity for medicine to adapt to new models of care. Telemedicine and telehealth have enabled medical care at a distance in various fields, including ophthalmology. The aim of this article is to review the current state and the opportunities for telemedicine in ophthalmology. Materials and methods PubMed, ScienceDirect Database, Google Scholar databases, as well as official sites of various governmental and non-governmental institutions were explored. The search was conducted between May 1, 2022 and July 31, 2022 using as key words “teleophthalmology”; “telemedicine/telehealth and ophthalmology”; “ophthalmology and COVID-19”. Results 87 primary sources were reviewed. An exploratory analysis of the current state and application of telemedicine in ophthalmology was made. Conclusion A great number of innovations have created an environment allowing for teleophthalmology to flourish, whereas the COVID-19 epidemic has accelerated the development and adoption of these digital technologies. Telemedicine has become an extremely valuable tool during a pandemic, and even if it would never fully replace in the person-to-person patient visits, it certainly has an important role in our dynamic and high-tech world.

Level of Doctors’ Satisfaction in Ophthalmology Telemedicine at the Philippine General Hospital

Objectives. This quantitative, cross-sectional, descriptive research aims to determine the level of satisfaction ofdoctors using telemedicine in Ophthalmology.Methods. An online questionnaire was sent to ophthalmologists at the Philippine General Hospital, a tertiary referral center, that partially shifted to ophthalmology telemedicine during the COVID-19 pandemic.Results. Respondents perceived telemedicine positively in terms of usefulness (Mean 2.92, Slightly Satisfied), ability to do quick follow-ups and patient updates (Mean 2.90, Slightly Satisfied), simplicity, and ease of use of technology (Mean 2.78, Slightly Satisfied). They were least satisfied with its effectiveness (Mean 2.37, Slightly Dissatisfied).Conclusion. Ophthalmologists expressed only slight satisfaction with telemedicine. The telemedicine platform was simple and useful for end-users, but some aspects may be improved based on questionnaire results.

Teleophthalmology in Saudi Arabia.

Teleophthalmology is the provision of ophthalmic care using digital medical equipment and telecommunications technology. While teleophthalmology has been practiced since the 1990s, it became a crucial medical service during the COVID-19 pandemic when doctors were required to make diagnoses from a distance. This was certainly the case in Saudi Arabia, a relatively large country with limited medical workforce to meet demands, yet a high prevalence of diseases such as diabetes, glaucoma, and cataracts which are considered leading causes of visual impairment. In response to the pandemic, Saudi Arabia's Ministry of Health issued scientific instruction manuals and guidelines for health-care providers which paved the way for increased use of digital technologies and solutions to mitigate the health and economic impacts of COVID-19. The pandemic served to accelerate the use of virtual ophthalmology in Saudi Arabia with the most common teleophthalmology applications being teleconsultation and disease-specific applications such as diabetic retinopathy and retinopathy of prematurity. Although some challenges relating to implementing teleophthalmology in Saudi Arabia remain, it is felt that there are great opportunities to expand the use of telemedicine in ophthalmology in this country.

Telemedicine and delivery of ophthalmic care in rural and remote communities: Drawing from Australian experience.

Rural and remote communities in Australia are characterised by small but widely dispersed populations. This has been proven to be a major hurdle in access to medical care services with screening and treatment goals repeatedly being missed. Telemedicine in ophthalmology provides the opportunity to increase the availability of high quality and timely access to healthcare within. Recent years has also seen the introduction of artificial intelligence (AI) in ophthalmology, particularly in the screening of diseases. AI will hopefully increase the number of appropriate referrals, reduce travel time for patients and ensure timely triage given the low number of qualified optometrists and ophthalmologists. Telemedicine and AI has been introduced in a number of countries and has led to tremendous benefits and advantages when compared to standard practices. This paper summarises current practices in telemedicine and AI and the future of this technology in improving patient care in the field of ophthalmology.

Outcomes of a Hybrid Ophthalmology Telemedicine Model for Outpatient Eye Care During COVID-19

The hybrid ophthalmology telemedicine model asynchronously pairs an imaging appointment by a technician with a subsequent virtual appointment by a clinician. Although it has been mentioned in several studies as an alternative to standard in-person care during the COVID-19 pandemic, outcomes of this alternative clinical care model remain to be evaluated. To investigate the outcomes associated with the hybrid ophthalmology telemedicine model during the COVID-19 pandemic for nonurgent and nonprocedural ophthalmological care. Retrospective, cross-sectional study of all hybrid visits scheduled during the year 2020 in a single academic, hospital-based eye clinic in Boston, Massachusetts. All hybrid ophthalmology telemedicine visits completed in the year 2020 by opthalmologists and optometrists were included. Data were analyzed from January to December 2020. Hybrid telemedicine clinical encounters. Four outcome metrics were calculated: (1) need for subsequent procedure visit, (2) medication change, (3) nonurgent, and (4) urgent consultation with another eye clinician. Adverse outcomes were defined as irreversible vision loss and the need for additional in-person evaluation to reach a management decision. From April 9 to December 30, 2020, 889 patients (506 female patients [56.9%]; mean [SD] age, 62.1 [14.5] years; age range, 13-98 years) completed 940 hybrid visits. The most common visit indications were glaucoma (424 visits [45.1%]) and retinal diseases (499 visits [53.1%]). A total of 25 visits (2.7%) led to a procedure, 22 visits (2.3%) led to a change in medication, and 44 visits (4.7%) were referred for nonurgent consultation with another subspecialty with no instances of urgent referrals. Sixteen patients (1.7%) were referred to the on-call clinician for a same-day emergency in-person visit or recommended for a subsequent standard in-person visit to reach a management decision. There were no cases of irreversible vision loss following a hybrid visit. These findings suggest that with the appropriate patient selection and clinical setting, the hybrid ophthalmology telemedicine model may be a good alternative to standard in-person visits, particularly for patients with glaucoma and retinal diseases.

Fractal dimension of retinal vasculature as an image quality metric for automated fundus image analysis systems

Automated fundus screening is becoming a significant programme of telemedicine in ophthalmology. Instant quality evaluation of uploaded retinal images could decrease unreliable diagnosis. In this work, we propose fractal dimension of retinal vasculature as an easy, effective and explainable indicator of retinal image quality. The pipeline of our approach is as follows: utilize image pre-processing technique to standardize input retinal images from possibly different sources to a uniform style; then, an improved deep learning empowered vessel segmentation model is employed to extract retinal vessels from the pre-processed images; finally, a box counting module is used to measure the fractal dimension of segmented vessel images. A small fractal threshold (could be a value between 1.45 and 1.50) indicates insufficient image quality. Our approach has been validated on 30,644 images from four public database.

Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology.

Background: The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. Methods: 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: “telemedicine”, “privacy”, “ophthalmology”, “COVID-19” and “informed consent”. Results: Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. Conclusions: Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.

Physician Satisfaction With Virtual Ophthalmology Clinics During the COVID-19 Pandemic: A Tertiary Eye Care Center Experience.

BackgroundIn this study, we aimed to assess ophthalmologists’ experience with teleophthalmology during the coronavirus disease 2019 (COVID-19) pandemic in the central region of Saudi Arabia. In addition, we evaluated their satisfaction level and explored their satisfaction determinants.MethodologyWe conducted an online survey for ophthalmologists who participated in the virtual ophthalmology clinic during COVID-19 between November 2020 and September 2021. The survey was used to evaluate ophthalmologists’ experience with teleophthalmology during the pandemic. Ophthalmologists were asked to measure their satisfaction with equipment and technical issues, communication, and clinical assessment, and to provide an overall program evaluation. Data were analyzed via frequency measures (e.g., numbers, percentages, mean, and standard deviation).ResultsOut of the 113 ophthalmologists who were invited to participate in our study, 71 completed the survey. In total, 23 (32.4%) participants were general ophthalmologists, 15 (21.1%) were subspecialists in the cornea, 16 (22.5%) were subspecialists in glaucoma, one (1.4%) was a subspecialist in neuro-ophthalmology, seven (9.9%) were subspecialists in pediatric ophthalmology, eight (11.3%) were subspecialists in the retina, and one (1.4%) participant was a subspecialist in oculoplastic. Overall, 56.3% of the respondents were satisfied with teleophthalmology. Ophthalmologists who subspecialized in the retina demonstrated higher levels of satisfaction than other subspecialties. The most common challenge reported by ophthalmologists in the virtual consultation was the lack of adequate equipment to evaluate the patients (53.5%), followed by technical issues (43.7%) and the patients’ lack of experience in using virtual consultation services (38%). Overall satisfaction score was the highest among ophthalmologists who reported providing at least five video consultations before the survey.ConclusionsThe findings from our study suggest that the subspeciality of ophthalmologists and the number of video consultations conducted by ophthalmologists are important determinants in their level of satisfaction with teleophthalmology. The majority of the respondents were satisfied with the virtual clinic during the COVID-19 pandemic. The current pandemic could pave the way for the future use of telemedicine in ophthalmology if virtual eye examinations become standardized.

Telemedicine and Ophthalmology Amidst covid-19: A Descriptive Study

Introduction: Doctors have had to adapt to an unknown and unexpected situation and within these changes it was necessary to use tools to which they have been a little reluctant to use, such as telemedicine to continue with the assessment of patients from different medical specialties such as ophthalmology. Aim: To show the results of the description of the experience of the practice of telemedicine in ophthalmology as a useful tool for access to a specialized consultation that would be decisive, during the time of the covid-19 pandemic in an ophthalmological center in Bogota Colombia. Materials and methods: A descriptive cross-sectional study was carried out including pediatric and adult patients who attended a telemedicine consultation with some of the 16 ophthalmologists of Oftalmosanitas, in the services of general ophthalmology, retina, glaucoma, cornea, pediatrics and uveitis, between 15 April and August 31, 2020. Variables such as age, sex, type of consultation, treating specialty, diagnosis and management plan were included. Results: Information was collected from 23,629 consultations, the average age was 53.6 years, 62.29% were women and 92.52% were of legal age. Regarding the perception of physicians, 100% considered that this consultation modality has been useful for the current contingency and that the majority of patients are satisfied with the care. Conclusions: The exercise of ophthalmology telemedicine in our institution managed to attend and solve a large number of consultations. In addition, this experience was widely accepted by doctors and patients as they gained access to specialized care that was able to solve most of the reasons for consultation by requesting diagnostic tests.

A Smartphone-Based Near-Vision Testing System: Design, Accuracy, and Reproducibility Compared With Standard Clinical Measures.

Ophthalmologic telemedicine has emerged during the COVID-19 pandemic. The objective of this study is to assess the accuracy and reproducibility of a smartphone-based home vision monitoring system (Sightbook) and to compare it with existing clinical standards. Near Snellen visual acuity (VA) was measured with Sightbook and compared with conventional measurements for distance and near VA at an academic medical center ophthalmology clinic in 200 patients with a variety of different specified preexisting ocular conditions. Measurements of contrast sensitivity were also compared by using an existing commercially available chart system in 15 normal patients and 15 patients with age-related macular degeneration. Sightbook VA tests were reproducible (SD = ±0.054 logMAR), and correlation with standard VA methods was significant (R > 0.87 and P < .001). Sightbook contrast sensitivity measurements were reproducible (SD/mean ratio, 0.02 to 0.04), yielding results similar to those of standard tests (R2 > 0.87 and P < .001). Smartphone-based VA and contrast sensitivity are highly correlated with standard charts and may be useful in augmenting limited inoffice care. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:79-84.].

Ophthalmic Telemedicine in the Pandemic–Endemic World: Present and Future Perspectives

COVID-19 restrictions have increased the need and use of telemedicine in ophthalmology but this approach requires remote data collection and reliable technologies to ensure accurate and safe examination and diagnosis. This article reviews the existing telemedicine technologies for age-related macular degeneration (AMD), diabetic retinopathy (DR) and paediatric ophthalmology, and discusses their applicability in the COVID-19 era. We conducted a literature search of PubMed using telemedicine keywords for all relevant pathologies (AMD, DR and paediatric ophthalmology) to identify English-language articles published between 2001 and 2021. We assessed whether existing telemedicine technologies would meet the needs of patients under COVID-19 restrictions. Our findings showed that there are reliable existing home-monitoring technologies. However, self-operated home optical coherence tomography is still an investigational technology for AMD monitoring and is not yet available for routine use. Computerized algorithms aimed at identifying DR pathology and or deterioration in relevant parameters under investigation have shown excellent results. In paediatric ophthalmology, parents can conduct basic testing of their child's ophthalmic parameters; improvements in parental testing will require the development of quick and reliable automatic instruments. In conclusion, current technologies lend themselves to remote use for ophthalmic examination by non-professional individuals, which is particularly relevant for ophthalmic care provision in the pandemic setting. Further investigative effort is needed in order to improve home monitoring and computerized data processing.

Validation d’un protocole de téléexpertise d’ophtalmologie en EHPAD

Assisted living residents are a fragile population with limited access to health care. In recent years, telemedicine has developed in several specialties, including ophthalmology. The main objective of our study is the validation of an ophthalmology telemedicine protocol in assisted living facilities. This is a retrospective, multicentric, descriptive study including 4 assisted living facilities in the Rennes area. An ophthalmic technician examined residents for one half-day per week. The examination was performed directly in the patient's room, in bed or in a chair, with portable equipment. An ophthalmologist from our service interpreted the results remotely on a deferred basis within 7 days. Appropriate medical or surgical care was then offered to the patient depending on the diagnosis. We included 113 residents. A complete, interpretable examination was achieved in 84.1% of cases. One or more ophthalmic conditions were diagnosed in 57.5% of the residents. Of the residents who were then seen at the university medical center, 65% underwent a scheduled surgical procedure or laser. Visual acuity was significantly improved subsequent to the telemedicine encounter. The success rate of a complete, interpretable examination allows us to now validate our nursing home examination procedure. In addition to bringing a large amount of initially unknown information to the medical and paramedical staff of the structure, ophthalmology telemedicine allows for a significant improvement in visual acuity. This project validated the feasibility of ophthalmology telemedicine in an assisted living setting. This protocol may also be applicable to other health care settings (penitentiaries, mental health institutions, etc.).

Patient and provider experience during real-time pediatric ophthalmology telemedicine consultations

Patient and provider experience during real-time pediatric ophthalmology telemedicine consultations

Evaluation of a Home-Printable Vision Screening Test for Telemedicine

Many ophthalmology appointments have been converted to telemedicine assessments. The use of a printed vision chart for ophthalmology telemedicine appointments that can be used by people who are excluded from digital testing has yet to be validated. To evaluate the repeatability of visual acuity measured using the Home Acuity Test (HAT) and the agreement between the HAT and the last in-clinic visual acuity. This diagnostic study was conducted from May 11 to 22, 2020, among 50 control participants and 100 adult ophthalmology outpatients who reported subjectively stable vision and were attending routine telemedicine clinics. Bland-Altman analysis of corrected visual acuity measured with the HAT was compared with the last measured in-clinic visual acuity on a conventional Early Treatment Diabetic Retinopathy Study logMAR chart. For control participants, repeatability of the HAT and agreement with standard logMAR visual acuity measurement. For ophthalmology outpatients, agreement with the last recorded in-clinic visual acuity and with the International Classification of Diseases and Related Health Problems, 11th Revision visual impairment category. A total of 50 control participants (33 [66%] women; mean [SD] age, 36.0 [10.8] years) and 100 ophthalmology patients with a wide range of diseases (65 [65%] women; mean [SD] age, 55.3 [22.2] years) were recruited. For control participants, mean (SD) test-retest difference in the HAT line score was -0.012 (0.06) logMAR, with limits of agreement (LOA) between -0.13 and 0.10 logMAR. The mean (SD) difference in visual acuity compared with conventional vision charts was -0.14 (0.14) logMAR (range, -0.4 to 0.18 log MAR) (-7 letters) in controls, with LOA of -0.41 to 0.12 logMAR (-20 to 6 letters). For ophthalmology outpatients, the mean (SD) difference in visual acuity was -0.10 (0.17) logMAR (range, -0.5 to 0.3 logMAR) (1 line on a conventional logMAR sight chart), with the HAT indicating poorer visual acuity than the previous in-clinic test, and LOA of -0.44 to 0.23 logMAR (-22 to 12 letters). There was good agreement in the visual impairment category for ophthalmology outpatients (Cohen κ = 0.77 [95% CI, 0.74-0.81]) and control participants (Cohen κ = 0.88 [95% CI, 0.88-0.88]). This study suggests that the HAT can be used to measure visual acuity by telephone for a wide range of ophthalmology outpatients with diverse conditions. Test-retest repeatability is relatively high, and agreement in the visual impairment category is good for this sample, supporting the use of printed charts in this context.

Ophthalmic practice in current COVID crisis

Corona virus (covid-19) pandemic has shaken the entire world, its wide spread transmission has restricted everybody's day to day life, ophthalmologists are no exception, but in greater danger, as most of ophthalmologic examinations include close contact between patient and doctor, increasing the risk of transmission of deadly covid-19 virus. Adopting certain measures in ophthalmic practice reduces the transmission risk. Various ophthalmic manifestations of covid 19 includes follicular conjunctivitis, viral keratoconjunctivitis, hemorrhagic and pseudomembranous conjunctivitis, Central retinal vein occlusion (CRVO), Central retinal artery occlusion (CRAO) Cerebrovascular accident (CVA) with vision loss, Mucormycosis etc. For this review, literature search was conducted in PubMed and Google Scholar databases by using terms coronavirus, SARS-CoV-2, COVID-19, ophthalmology, ophthalmologist, telemedicine in ophthalmology and their combinations to gather efficient information that can enhance the daily practice. Most important modifications include personal protective equipment, environmental measures (air ventilation, instrument handling), administrative measures (physical distancing, triage setup). Vaccination plays a crucial role in hampering the effect of covid crisis, it should be given significant importance and extensive awareness. Telemedicine can change the entire scenario in doctor-patient relationship and everyone should have thorough knowledge about its guidelines. All these measures need gigantic efforts in reducing the covid-19 effect, paving the path for the “NEW-NORMAL”.

Continuing ophthalmology practice in crisis - Lessons from COVID-19 pandemic.

Dr. Li Wenliang, a fellow ophthalmologist from Wuhan, China had attempted to warn his colleagues of a novel severe acute respiratory illness ultimately succumbing to this novel disease on February 7, 2020.[1] Over the next few months, not only did the virus paralyze the world, but it managed to evolve into a pandemic of epic proportions which the new world had not seen since the Spanish flu. COVID-19 has adversely affected all aspects of life including medical care. The Ophthalmology department has been equally affected by the shut-down of smaller practices with complete cessation of elective surgeries such as refractive and cataract surgery. Due to the nationwide lockdown, most cases were being referred to higher centers which were still difficult to access due to the absence of transport and this impact of lockdown on ophthalmic practice was aptly described by Nair et al.[2] A study done in our center showed that ocular trauma surgeries followed by vitreoretinal surgeries were the two most commonly performed surgeries during the lockdown.[3] The demographics of these patients during lockdown was also emphasized with maximum patients being local in origin. It also highlighted the role of a dedicated hospital infection control committee (HICC) that not only implemented infection control practices but also provided active surveillance of any COVID-19 patients. We put forth the effectivity of novel concepts such as avoidance of contact procedures like applanation, direct ophthalmoscopy, use of breath-shields on slit lamps and indirect ophthalmoscope. Every patient presenting to our emergency department underwent detailed history taking and was provided with hand sanitizer and a surgical mask prior to contact with a health care worker (HCW). Not only did our center provide guidelines in managing vitreoretinal surgeries during the lockdown, we even described guidelines for management of intravitreal injections during the lockdown period and thereafter.[4] It was Unlock-I which was announced by the Government of India from June 8, 2020 that came as a respite not only for ophthalmologists nationwide but also for the patients. During Unlock-I centers resumed services other than emergencies with their own set of protocols. Pre-operative COVID testing became the norm in certain centers and was usually done within 72 h of the surgery. A positive COVID test mandated delay of elective surgeries as well as stringent contact tracing and risk assessment of any HCW exposed to the patient. These measures mitigated the risk of contracting COVID-19 among the HCW. Fixed percentage of HCW‘s of all specialities continued manning the COVID wards of hospitals. Even during Unlock-I there were tailored restrictions across state lines along with the constant fear of contracting COVID-19. Hence the reduced footfall of patients continued despite India entering Unlock-I. This brought forth unique challenges to hospitals with resident/fellow training programs. These new challenges required educational reform, policy making and restructuring of training programs.[5] The study published in this issue of the journal succinctly describes the trials and tribulations that were faced by ophthalmic practices not only in South India but also across the country.[6] The drastic decrease in new as well as follow-up patients and the reduction in surgeries has plagued ophthalmic practices across the board. The study has also ably described the causes leading to the drastic reduction of workload despite Unlock-I. Despite the greatest efforts of providing an entire network of eye care centers, there were still a few lacunae in providing permanent eye care closer to the communities which COVID-19 managed to exploit. Even the role of telemedicine in ophthalmology remains limited and should only be used to advise first-aid and triaging.[7] COVID-19 has brought forth the deficiencies in eye care provision to the vulnerable population. The need to develop permanent eye care facilities closer to the communities has now become of utmost importance and requires aggressive reforms for accessible eye care.

Ophthalmology practice during COVID-19 pandemic: A survey of Indian ophthalmologists.

Purpose:To assess the ophthalmic practice pattern among ophthalmologists in India amidst the COVID-19 pandemic.Methods:An online questionnaire-based analysis was performed among members of the All India Ophthalmological Society (AIOS) and results were analyzed using SPSS software version 20.Results:A total of 2253 responses were received. The majority of the participants (72.6%) were between 30 and 60 years of age and were into private practice (64.7%). During the lockdown, over one-third of participant ophthalmologists reported not attending any OPD patients, whereas a majority (64%) provided only emergency ophthalmic services. During the COVID-19 pandemic, <15% surgeries were performed compared to the pre-COVID-19 era by 81% of participants, whereas elective surgeries were performed by only 4.3%. The proportion of participants utilizing telemedicine in ophthalmology showed a two-fold rise from the pre-COVID-19 era (21.9%) to the COVID-19 pandemic (46%). Over half of the participants reported following the AIOS guidelines, reducing clinic hours, use of screening questionnaires, minimizing staff, and use of breath shield on a slit lamp as precautionary measures to reduce the exposure. Over 95% of ophthalmologists were satisfied (score > 5/10) by the AIOS guidelines for ophthalmic practice during COVID-19.Conclusion:COVID-19 pandemic has adversely affected the ophthalmic care services across India with telemedicine emerging as a major rescue. The majority of practicing ophthalmologists are satisfied with guidelines provided by AIOS for ophthalmic care during the COVID-19 pandemic and have implemented the same in their setup.

Implementing Telemedicine Visits in an Underserved Ophthalmology Clinic in the COVID-19 Era.

Introduction:Many of the potential barriers to providing telehealth services already disproportionately impact vulnerable populations. The purpose of this study was to assess the incorporation of synchronous ophthalmology telemedicine visits in a tertiary university-based ophthalmology clinic for low-income and uninsured patients in the COVID-19 era.Methods:The records of 18 patients who were due for an in-person visit in the medically underserved patient clinic at our institute were reviewed. Patients considered high risk of ocular morbidity progression were approved to proceed with an in-person visit. Patients with non-urgent visit indications were attempted to be contacted by telephone to be offered a telemedicine telephone visit as an alternative to a postponed in-person office visit.Results:Clinical triage by an attending ophthalmologist determined that 17 patients (94.4%, n = 18) had visit indications appropriate for evaluation by telemedicine. Six patients (35.3%, n = 17) were successfully contacted and offered a telemedicine visit as an alternative to a postponed in-person office visit. All 6 patients accepted, scheduled, and completed a telemedicine visit. Eleven patients (64.7%, n = 17) were not able to be successfully contacted to offer and schedule either a telemedicine visit or a postponed in-person office visit. Patients who were not able to be successfully contacted were on average younger in age and more likely to be female, Hispanic/Latino, from Latin America, with a preferred language of Spanish.Conclusions:Synchronous ophthalmology telemedicine visits can be successfully incorporated in a tertiary university-based setting for low-income and uninsured patients. The primary barrier to providing telemedicine visits in this population was the ability to successfully contact patients to offer and schedule these visits.