Evaluation of Teleophthalmology During The COVID-19 Pandemic At A Single Outpatient Clinical Practice

Abstract

Purpose : The COVID-19 pandemic has necessitated a global paradigm shift regarding healthcare delivery, replacing the traditional in-office visit with a virtual platform, in order to limit viral exposure and spread. The purpose of this study is to evaluate agreement between the diagnosis and management of common eye diseases seen in virtual eye care visits versus traditional in-office visits.

Methods : This is a retrospective chart review of patients who presented to a single center for a video televisit between March and June 2020. Agreement was based on a qualitative comparison between the documented primary diagnosis and treatment plan at the first synchronous video visit and first subsequent in-office visit.

Results : During the NY State Lockdown, a single-center practice saw 779 distinct patients virtually. The most common diagnostic categories were Lids/Adnexa (29%), Cornea (18%), and Glaucoma (16%). Of these, 425 (55%) were subsequently seen at an in-office visit. When comparing the primary diagnosis at the two visits, a similar diagnostic code was maintained for 354 patients (83%). There were no known significant adverse outcomes for any patient seen virtually.

Medication changes were made at 268 (34%) video visits. These were guided by symptoms and external exams, although a minority were prophylactic or part of post-operative care. The new treatment plan was maintained for the same diagnosis at 50% of the subsequent in-office visits. Overall, there was an escalation of care for 131 patients (31%), a de-escalation of care for 32 patients (7.5%), and no change in management for 257 patients (60.1%) at the follow-up traditional office visit. Glaucoma patients were the most likely to require additional management (either drops or procedural intervention) when seen in the office.

Conclusions : Based on the results of this study, teleophthalmology provides a safe, feasible, and fairly accurate means of providing routine outpatient eye care.[1] There was an agreement in diagnoses between the virtual and traditional visit in 83% of patients and management plans remained unchanged for at least 60% of patients. Particularly given the importance of the ophthalmic exam, there are limitations to this model of care resulting in missed diagnoses or escalations of care. Addressing these limitations will require further investigation. 1. Tan et al., J Telemed Telecare, 2017.

This is a 2021 ARVO Annual Meeting abstract.