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Jack AI, Digney HT, Bell CA, Grossman SN, McPherson JI, Saleem GT, Haider MN, Leddy JJ, Willer BS, Balcer LJ, Galetta SL, Busis NA, Torres DM. Testing the Validity and Reliability of a Standardized Virtual Examination for Concussion. Neurol Clin Pract 2024; 14:e200328. [PMID: 38895642 PMCID: PMC11182663 DOI: 10.1212/cpj.0000000000200328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/27/2024] [Indexed: 06/21/2024]
Abstract
Background and Objectives We determined inter-modality (in-person vs telemedicine examination) and inter-rater agreement for telemedicine assessments (2 different examiners) using the Telemedicine Buffalo Concussion Physical Examination (Tele-BCPE), a standardized concussion examination designed for remote use. Methods Patients referred for an initial evaluation for concussion were invited to participate. Participants had a brief initial assessment by the treating neurologist. After a patient granted informed consent to participate in the study, the treating neurologist obtained a concussion-related history before leaving the examination room. Using the Tele-BCPE, 2 virtual examinations in no specific sequence were then performed from nearby rooms by the treating neurologist and another neurologist. After the 2 telemedicine examinations, the treating physician returned to the examination room to perform the in-person examination. Intraclass correlation coefficients (ICC) determined inter-modality validity (in-person vs remote examination by the same examiner) and inter-rater reliability (between remote examinations done by 2 examiners) of overall scores of the Tele-BCPE within the comparison datasets. Cohen's kappa, κ, measured levels of agreement of dichotomous ratings (abnormality present vs absent) on individual components of the Tele-BCPE to determine inter-modality and inter-rater agreement. Results For total scores of the Tele-BCPE, both inter-modality agreement (ICC = 0.95 [95% CI 0.86-0.98, p < 0.001]) and inter-rater agreement (ICC = 0.88 [95% CI 0.71-0.95, p < 0.001]) were reliable (ICC >0.70). There was at least substantial inter-modality agreement (κ ≥ 0.61) for 25 of 29 examination elements. For inter-rater agreement (2 telemedicine examinations), there was at least substantial agreement for 8 of 29 examination elements. Discussion Our study demonstrates that the Tele-BCPE yielded consistent clinical results, whether conducted in-person or virtually by the same examiner, or when performed virtually by 2 different examiners. The Tele-BCPE is a valid indicator of neurologic examination findings as determined by an in-person concussion assessment. The Tele-BCPE may also be performed with excellent levels of reliability by neurologists with different training and backgrounds in the virtual setting. These findings suggest that a combination of in-person and telemedicine modalities, or involvement of 2 telemedicine examiners for the same patient, can provide consistent concussion assessments across the continuum of care.
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Affiliation(s)
- Alani I Jack
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Helena T Digney
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Carter A Bell
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Scott N Grossman
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Jacob I McPherson
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Ghazala T Saleem
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Mohammad N Haider
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - John J Leddy
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Barry S Willer
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Laura J Balcer
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Steven L Galetta
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Neil A Busis
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Daniel M Torres
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
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Oganov AC, Chou TY, Hanson PM, Abazari A, Kung P, Weissbart SB, Lenoci JN, Honkanen RA. Telemedicine at a University Ophthalmology Practice During the Beginning of the COVID-19 Pandemic. Clin Ophthalmol 2024; 18:2369-2380. [PMID: 39193320 PMCID: PMC11348924 DOI: 10.2147/opth.s460454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
Purpose The aim of the research was to evaluate the use of teleophthalmology at a university practice during the COVID-19 pandemic, specifically examining precision, effectiveness, and patient satisfaction. Patients and Methods Telemedicine visits were offered to new and established patients requesting appointments with the Stony Brook University Department of Ophthalmology between March 30 and June 2, 2020. Records from these visits were reviewed for chief complaint, past medical and ocular history, diagnoses, treatment/management, and providers' sub-specialty. Precision was determined by comparing agreement between diagnoses of the telemedicine visit with those of the subsequent in-person visit. The decision to follow up in person was made by the physician and patient. Diagnostic precision as well as progression, improvement, or stability of patients' symptoms were determined by the physician's assessment at follow-up visits. Post-telemedicine visit satisfaction surveys were sent to all patients. Results Telemedicine visits were offered to 783 patients, 520 (66.4%) of whom accepted. Of these 520 patients, 409 (78.7%) were established and 105 (20.2%) had in-person, follow-up visits. Overall, the diagnostic precision of the follow-up visits was 89.5%. Precision differed significantly across ophthalmologic subspecialties. Of the patients who had in-person follow-up visits, 56.8% remained stable, 32.4% improved, and 10.8% worsened. Established patients presented with more extensive ocular histories/procedures and experienced a higher percentage of worsening symptoms/disease stage compared to new patients. Oculoplastics/orbit was the most prevalent diagnostic subspecialty that worsened. Surveys were sent to all patients completing telemedicine visits, 15.0% of whom responded. Overall satisfaction was 91.9%, although only 23.0% of respondents preferred telemedicine to an in-office visit. Conclusion Telehealth provides high levels of precision and patient satisfaction for a wide range of ophthalmologic visits, although most patients still prefer in-office examinations. Employing teleophthalmology for follow-up and emergency care may provide patients with an effective alternative during pandemic situations and beyond.
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Affiliation(s)
- Anthony C Oganov
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Timothy Y Chou
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Paris M Hanson
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Azin Abazari
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Preston Kung
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Sarah B Weissbart
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Jacqueline N Lenoci
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Robert A Honkanen
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
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Parikh AA, Liebman DL, Armstrong GW. A Novel Ophthalmic Telemedicine Program for Follow-Up of Minor Ophthalmic Emergencies. Telemed J E Health 2024; 30:835-840. [PMID: 37751196 DOI: 10.1089/tmj.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Background: Near-term follow-up for minor ophthalmic emergencies is important to ensure positive patient outcomes but can impose logistical challenges for patients and ophthalmology practices. While ophthalmic telemedicine has been used for screening and triage, its feasibility and safety for follow-up care for minor ophthalmic emergencies have not been reported. The objective of this study was to report initial results of a novel virtual emergency department (ED) follow-up clinic. Methods: Retrospective cross-sectional study of patients discharged from the ophthalmic ED who required near-term follow-up and carried diagnoses suitable for virtual evaluation, between December 6, 2021, and June 26, 2022, at a single tertiary eye care center. Main outcome measures included missed appointment rate, time interval between ED encounter and virtual follow-up, clinical diagnoses, and referrals after telemedicine follow-up (including for urgent ambulatory and ED evaluation). Results: A total of 145 virtual visits were scheduled with 99 (68.3%) completed appointments, yielding a no-show rate of 31.7%. Of the completed visits, the mean time interval between ED evaluation and virtual follow-up was 8.3 days (standard deviation ±3.9). Eighty-four (84.9%) visits were video-based and 15 (15.1%) were audio-only. Seventy-nine (94%) had at least one aspect of the ophthalmic examination documented. The most common diagnoses were chalazion (18), conjunctivitis (13), corneal abrasion (12), and encounter after corneal foreign body removal (7). After virtual follow-up, 23 patients (23.2%) had subsequent referrals, and no patients re-presented to the ophthalmic ED. Conclusions: Ophthalmic telemedicine may be a safe and feasible modality for providing timely post-acute near-term follow-up care for patients with appropriate ophthalmic diagnoses.
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Affiliation(s)
- Ayush A Parikh
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel L Liebman
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Grayson W Armstrong
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Tang J, Pei Y, Wang J, Yan N, Luo Y, Zhou W, Wang X, Wang W. The association between Chinese eye exercises and myopia in children and adolescents: A systematic review and meta-analysis. Front Public Health 2023; 11:950700. [PMID: 36969666 PMCID: PMC10036375 DOI: 10.3389/fpubh.2023.950700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 02/10/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectiveThis study aims to summarize the relevant evidence on the association between eye exercises and myopia in children and adolescents in China.MethodsThe meta-analysis pooled the results of 12 studies, with a total of 134,201 participants. Another five studies (no OR for myopia as an outcome and meeting inclusion criteria) were reported in the systematic review. We searched PubMed, Web of Science, CNKI, Wan Fang, and reference lists of retrieved studies. Association estimates were pooled using random-effects meta-analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) for eye exercises and myopia were pooled from a meta-analysis.ResultsAfter standardizing the reference values, a pooled OR of the univariate analysis showed a 24% reduction in myopia in children and adolescents who performed eye exercises (OR = 0.76; 95% CI: 0.62–0.89). After adjusting the covariate, a pooled OR of multiple logistic analysis for myopia (OR = 0.87; 95% CI: 0.72–1.02) showed that there is no significance between eye exercises and myopia. However, in subgroup studies of the multivariate analysis, the large sample (OR = 0.84; 95% CI: 0.74–0.94) and Chinese database (OR = 0.80; 95% CI: 0.67–0.93) subgroup showed modest protective effects. In addition, five studies in the systematic review also evaluated the risk of myopia events, and Chinese eye exercises had a modest protective effect on myopic control, but the incorrect performance of and attitude toward eye exercises posed negative effects on their eyesight health.ConclusionChinese eye exercises have a modest protective effect on myopic control, but considering that the incorrect performance of and attitude toward eye exercises have a significant influence on the effect of eye exercises, the effect of eye exercises may not be enough to prevent the progress of myopia in the long term, and more standardized eye exercises need to be conducted.
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Affiliation(s)
- Jie Tang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yifei Pei
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jingjing Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Na Yan
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yunjiao Luo
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wen Zhou
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaojuan Wang
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Xiaojuan Wang
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Engineering Research Innovation Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
- *Correspondence: Wei Wang
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Sanayei N, Albrecht MM, Martin DC, Marin N, Fereshetian S, Baker S, Subramanian ML, Ness S, Siegel NH, Chen X. Outcomes of a Hybrid Ophthalmology Telemedicine Model for Outpatient Eye Care During COVID-19. JAMA Netw Open 2022; 5:e2226292. [PMID: 36006645 PMCID: PMC9412225 DOI: 10.1001/jamanetworkopen.2022.26292] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Nedda Sanayei
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | | | - Diana C. Martin
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Nicolas Marin
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Steven Baker
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Manju L. Subramanian
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Steven Ness
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Nicole H. Siegel
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Xuejing Chen
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
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