COVID-19 Launches Retinal Telemedicine into the Next Frontier

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.

Examining Global Crises: Extracting Insights From the COVID-19 Pandemic and Natural Disasters to Develop a Robust Emergency Diabetic Retinopathy Strategy for Puerto Rico

In this critical analysis, we investigate the profound impact of natural disasters and pandemics on the care and adherence to treating diabetic retinopathy, a severe complication of diabetes requiring continuous monitoring and treatment to prevent vision loss. Our study also sheds light on the social and economic context of Puerto Rico, emphasizing recent emergency events that have exacerbated existing public health challenges. Through a comprehensive review of relevant literature from PubMed, Google Scholar, and the George Washington University Himmelfarb Health Sciences Library database, we identified 31 pertinent articles out of 45 evaluated, focusing on the effects of these crises on healthcare delivery, diabetic retinopathy screening, and treatment. The evidence strongly indicates that during such emergencies, barriers to healthcare escalate, leading to significant treatment delays and a reduction in diabetic retinopathy screening and diagnosis, ultimately resulting in deteriorated visual outcomes. Thus, our review underscores the urgent need for the development of effective emergency plans tailored specifically to diabetic retinopathy, particularly in Puerto Rico, where diabetes prevalence and its complications are notably higher. Such plans should not only incorporate established emergency measures but also harness emerging technological advances in the field of ophthalmology to ensure optimal preparedness for future pandemics and natural disasters.

Equivalence of the autism spectrum disorders diagnostics in children in telemedicine and face-to-face consultations: a literature review

BACKGROUND

The use of remote forms of mental health care has become widespread during the period of epidemiological restrictions due to the COVID-19 pandemic. Methodological and organizational issues remain insufficiently developed, including the level of equivalence of the use of telemedicine technologies in the diagnosis of autistic spectrum disorders.

AIM

Study of the equivalence of diagnostic tools in the framework of telemedicine and face-to-face consultations in children with autistic spectrum disorders according to modern scientific literature.

METHODS

A descriptive review of scientific studies published between January 2017 and May 2023 was carried out. The papers presented in the electronic databases PubMed, Web of Science, and eLibrary were analyzed. Descriptive analysis was used to summarize the obtained data.

RESULTS

The conducted analysis convincingly indicates sufficient equivalence of remote tools used in different countries for level I screening, assessment scales, and structured procedures for diagnosing autistic spectrum disorders with a high level of specificity from 60.0 to 94.4%, sensitivity from 75 dog 98.4%, and satisfaction of patients and their legal representatives.

CONCLUSION

The widespread use of validated telemedicine diagnostic systems in clinical practice contributes to the early detection of autistic spectrum disorders, increasing the timeliness and effectiveness of medical, corrective psychological, pedagogical, and habilitation interventions.

Follow-up Rates After Teleretinal Screening for Diabetic Retinopathy: Assessing Patient Barriers to Care

Purpose: To study patient follow-up after they engage in a teleretinal screening program and to understand potential barriers to care. Methods: This was a retrospective analysis and a prospective study of telephone-based patient interviews of outpatients screened for diabetic retinopathy (DR) through a teleretinal referral system. Results: Of 2761 patients screened through a teleretinal referral program, 123 (4.5%) had moderate nonproliferative DR (NPDR), 83 (3.0%) had severe NPDR, and 31 (1.1%) had proliferative DR. Of the 114 patients with severe NPDR or worse, 67 (58.8%) saw an ophthalmologist within 3 months of referral. Eighty percent of interviewed patients reported they were not aware of the need for follow-up eye appointments. Conclusions: Of patients with severe retinopathy or worse, 58.8% presented for in-person evaluation and treatment within 3 months of screening. Although this result was negatively affected by factors related to the COVID-19 pandemic, key elements of patient education and improved referral strategies to facilitate in-person treatment are essential to improving follow-up after patients engage in telescreening.

Availability of Medical Services and Teleconsultation during COVID-19 Pandemic in the Opinion of Patients of Hematology Clinics-A Cross-Sectional Pilot Study (Silesia, Poland)

A new virus, SARS-CoV-2, emerged in December 2019, triggering the COVID-19 pandemic in 2020 due to the rapid spread and severity of cases worldwide. In Poland, the first case of COVID-19 was reported on 4 March 2020. The aim of the prevention efforts was primarily to stop the spread of the infection to prevent overburdening the health care system. Many illnesses were treated by telemedicine, primarily using teleconsultation. Telemedicine has reduced personal contact between doctors and patients and reduced the risk of exposure to disease for patients and medical personnel. The survey aimed to gather patients' opinions on the quality and availability of specialized medical services during the pandemic. Based on the data collected regarding patients' opinions on services provided via telephone systems, a picture was created of patients' opinions on teleconsultation, and attention was drawn to emerging problems. The study included a 200-person group of patients, realizing their appointments at a multispecialty outpatient clinic in Bytom, aged over 18 years, with various levels of education. The study was conducted among patients of Specialized Hospital No. 1 in Bytom. A proprietary survey questionnaire was developed for the study, which was conducted on paper and used face-to-face interaction with patients. Results: 17.5% of women and 17.5% of men rated the availability of services during the pandemic as good. In contrast, among those aged 60 and over, 14.5% of respondents rated the availability of services during the pandemic as poor. In contrast, among those in the labor force, as many as 20% of respondents rated the accessibility of services provided during the pandemic as being well. The same answer was marked by those on a pension (15%). Overwhelmingly, women in the age group of 60 and over showed a reluctance toward teleconsultation. Conclusions: Patients' attitudes toward the use of teleconsultation services during the COVID-19 pandemic varied, primarily due to attitudes toward the new situation, the age of the patient, or the need to adapt to specific solutions not always understood by the public. Telemedicine cannot completely replace inpatient services, especially among the elderly. It is necessary to refine remote visits to convince the public of this type of service. Remote visits should be refined and adapted to the needs of patients in such a way as to remove any barriers and problems arising from this type of service. This system should also be introduced as a target, providing an alternative method of inpatient services even after the pandemic ends.

Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care

Purpose of Review

In this article, we reviewed the impact resulting from the COVID-19 pandemic on the traditional model of care in ophthalmology.

Recent Findings

Though virtual eye care has been present for more than 20 years, the COVID-19 pandemic has established a precedent to seriously consider its role in the evolving paradigm of vision and eye care. New hybrid models of care have enhanced or replaced traditional synchronous and asynchronous visits. The increased use of smart phoneography and mobile applications enhanced the remote examination of patients. Use of e-learning became a mainstream tool to continue accessing education and training.

Summary

Teleophthalmology has demonstrated its value for screening, examining, diagnosing, monitoring treatment, and increasing access to education. However, much of the progress made following the COVID-19 pandemic is at risk of being lost as society pushes to reestablish normalcy. Further studies during the new norm are required to prove a more permanent role for virtual eye care.

Impact of the COVID-19 Pandemic on the Metabolic Control of Diabetic Patients in Diabetic Retinopathy and Its Screening

(1) Background: Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM), screening programs of which have been affected by the COVID-19 pandemic. The aim of the present study was to determine the impact of the COVID-19 pandemic on the screening of diabetes patients in our healthcare area (HCA). (2) Methods: We carried out a retrospective study of patients with DM who had attended the DR screening program between January 2015 and June 2022. We studied attendance, DM metabolic control and DR incidence. (3) Results: Screening for DR decreased in the first few months of the pandemic. The incidence of mild and moderate DR remained stable throughout the study, and we observed little increase in severe DR, proliferative DR and neovascular glaucoma during 2021 and 2022. (4) Conclusions: The current study shows that during the COVID-19 pandemic, screening program attendance decreased during the year 2020, which then recovered in 2021. Regarding the most severe forms of DR, a slight increase in cases was observed, beginning in the year 2021. Nevertheless, we aimed to improve the telemedicine systems, since the conditions of a significant proportion of the studied patients worsened during the pandemic; these patients are likely those who were already poorly monitored.

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

IMPORTANCE

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.

OBJECTIVE

To investigate the outcomes associated with the hybrid ophthalmology telemedicine model during the COVID-19 pandemic for nonurgent and nonprocedural ophthalmological care.

DESIGN, SETTING, AND PARTICIPANTS

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.

EXPOSURES

Hybrid telemedicine clinical encounters.

MAIN OUTCOMES AND MEASURES

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.

RESULTS

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.

CONCLUSIONS AND RELEVANCE

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.

Impact of the COVID-19 pandemic on visual outcomes of diabetic macular edema patients at a tertiary care veterans affairs center

Purpose

There are limited studies on factors that impacted retina clinic patient outcomes during the COVID-19 pandemic. We aimed to evaluate visual and anatomic outcomes in patients with diabetic macular edema (DME) requiring anti-VEGF injections at the veterans' affairs tertiary care eye clinic in Houston, TX.

Methods

Patient volume from April 2020 was compared to that of April 2019 to determine attendance changes. To evaluate outcomes, we reviewed patients with DME who had scheduled appointments during April 2020. We tracked changes in central foveal thickness (CFT) and Snellen visual acuity (VA) measurements. Patient outcomes were classified as poor (defined as worsening VA or CFT at follow-up) or good (no worsening of either at follow-up). Regression analysis identified characteristics associated with poor outcomes.

Results

To prevent the spread of COVID-19, patients were called to reschedule clinic appointments. Attendance frequency decreased from 523 patients in April 2019 to 246 patients in April 2020. 134 patients met inclusion criteria (mean age of 64.7 ± 8.8 years). 19/134 of patients were seen on schedule, 89/134 had delayed appointments (average follow-up interval of 115.2 ± 50.0 days), and 26/134 were lost to follow-up. Patients with delayed appointments had higher odds of poor outcome at follow-up compared to patients seen on schedule (OR = 4.03, 95% CI: 1.14-16.92, p = 0.04). Patient's baseline visual acuity, macular thickness, comorbidities, and diabetic retinopathy severity, and demographics did not affect visual outcome at follow-up.

Conclusions

On average, patients were rescheduled to a visit 2.4 months later than their usual visit. Over half these patients experienced worsening of vision or edema. This demonstrates that lapses in care result in worsening of DME. However, there is no clear association between baseline characteristics and risk of disease progression.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01049-5.