Practice survival in the COVID-19 era

Reviewed by Terri-Diann Pickering, MD

COVID-19 changed the world in many ways, especially in the way doctors practice medicine.

The need for social distance to prevent the spread of coronavirus provided the perfect time for telemedicine to thrive, according to Terri-Diann Pickering, MD, clinical instructor at California Pacific Medical Center and board member of the Research Foundation. of glaucoma. .

Before the virus arrived, the use of telemedicine was relatively limited
to patients living in isolated areas away from medical centers.

The technology provided a remote control facilitated by a laptop
imaging devices.

Related: Removal of barriers to large-scale telemedicine adoption

In ophthalmology, telemedicine has facilitated the screening of diabetic retinopathy, corneal and external eye diseases, and pediatric ophthalmology.

Telecommunications have also facilitated international collaboration between specialists and in developing countries to cover rural patients.

However, activity was limited before COVID-19. That changed in early 2020.

Li Wenliang, MD, was the first ophthalmologist to die of the virus in February 2020 after examining a glaucoma-infected patient.

About 5 weeks later, the American Academy of Ophthalmology recommended postponing elective procedures and office visits.

Shortly afterwards a public health emergency was declared and the telemedicine privacy requirements in the United States were waived.

Related: Li Wenliang: hero ophthalmologist

“An analysis1 showed that ophthalmology lost more patient volume as a result of the pandemic than any other specialty, ”Pickering reported.

This was the time when ophthalmology practices were virtualized, both to provide patient and non-emerging care and reassurance to patients and staff with social distancing.

He noted that the volume of patients decreased by 97% for the treatment of cataracts and 88% for glaucoma.2

Overall, 81% of ophthalmology volume was lost during the months of March and April 2020 compared to the same period last year.1

Pros and cons of teleophthalmology

The areas in ophthalmology for which telemedicine is especially beneficial are for the treatment of diabetic retinopathy, retinopathy of prematurity, and corneal and external diseases.

Pickering also said the technology is good for triage, as it can reduce the number of office visits and costs.

Unfortunately, telemedicine has been less useful in glaucoma due to the difficulty in measuring IOP. “It’s not the same as a face-to-face exam,” he stressed.

However, virtual exams grew out of necessity and the available technology was put to use.

Related: Pearls to educate patients about ocular telemedicine options

When performing a virtual eye exam, doctors can use online charts to measure visual acuity.

IOP can be measured using the iCare Home monitoring device, and the optic nerve head can theoretically be assessed using cell phones and adapters;
a Triggerfish contact lens sensor (Sensimed) is another potentially useful device for measuring IOP, although setting up this technology can be difficult for patients at home, he noted.

A low-tech visual field examination can be performed showing patients how to perform confrontational visual fields.

Phone and online applications, virtual reality headsets, and other devices such as ForeseeHome (Notal Vision) and Eyecatcher (HP Inc) are also available.

However, these devices may not detect early visual field loss. You can use a pocket background camera or a phone app with an adapter to assess the optic nerve head, but this requires dilation and an assistant.

Related: Emerging opportunities – and risks – with telehealth in a pandemic

The GlobeChek Kiosk is a relatively new device that performs 11 tests in less than 10 minutes without the need for expansion.

“This was devised to help address the lack of a complete eye exam, especially for patients with diabetes,” he said.

A year later
When the pandemic began, examinations with slit lamps were considered high-risk procedures for disease transmission, but now they are not.

As Pickering explained, there have been no serious outbreaks related to ophthalmology since masks and other protocols were put in place.

As a result, the use of telemedicine has decreased significantly or stopped altogether.

A survey conducted by the Foundation for Glaucoma Research found that most patients would rather wait 6 weeks to get an appointment at the office than an appointment at the virtual office in 2 weeks.

By June 2020, most practices had reopened and resumed appointments, and telemedicine appointments declined markedly. By October, outpatient visits had returned to baseline.

Related: COVID-19 creates interruptions, an opportunity for ophthalmology

The future
Pickering remarked that in the future, doctors will need easily accessible hardware.

This list could include wireless or easy-to-use implantable PIO sensors; smart contact lenses; the ability to take angle images; online or application-based visual field testing; a home visual field device; and a portable hand-held optical coherence tomography scanner to assess the optic nerve.

According to Pickering, teleglaucoma is here to stay because of the concept of crisis preparedness.

“Technological advances will help improve accuracy and diagnosis,” Pickering concluded. “Expansion
of medical and non-medical use of online programs due to COVID-19 will increase patient and physician acceptance ”.

See more Glaucoma 360 coverage

Terri-Diann Pickering, MD
E: [email protected]
Pickering is an Aerie consultant.


1. Analysis: Ophthalmology lost more patient volume due to COVID-19 than any other specialty. Layer decision technology. May 11, 2020. Consulted
July 1, 2021.

2. Leonard C. Telemedicine in COVID-19 times. Ophthalmology Review. May 6, 2020. Accessed July 1, 2021.

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