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Castillejo Becerra CM, Wagner LH. Telemedicine in Oculoplastic Surgery During the COVID-19 Pandemic: A Single Center Experience. Telemed J E Health 2024; 30:e1736-e1741. [PMID: 38350121 DOI: 10.1089/tmj.2023.0401] [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: 02/15/2024] Open
Abstract
Purpose: To investigate patterns in oculoplastic surgery telemedicine visits at our institution during the pandemic period. Methods: Retrospective chart review of all patients who had a virtual consultation with the oculoplastic surgery service at Mayo Clinic Rochester between March 1, 2020, and March 1, 2021. Results: There were a total of 148 patients. Mean age was 65 years (95% confidence interval [CI]: 62-68). The mean driving distance to the medical center was 468 kilometers (95% CI: 352-586) and 15 (10%) patients came from states with no practicing American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members. Out of the 205 virtual visits, 35 (17%) were new, 45 (22%) were return, and 125 (61%) were postoperative. Conversion rate to surgery was 60%. A comparison between type of virtual visits (new vs. return vs. postoperative) revealed that a diagnosis of eyelid malposition was most frequent in postoperative visits (p = < 0.001), skin malignancy was most frequent in new visits (p = 0.009), and orbital tumors (p = 0.018) and thyroid eye disease (p = < 0.001) were most frequent in return visits. Most virtual encounters had supportive media attached including external photographs in 127 (62%) visits and other imaging or testing in 18 (9%) visits. The average virtual visit lasted 18 min (95% CI: 14-22) with technical difficulties noted in 9 (4%) visits. Unanticipated conversion to in-person visits was noted in three (1%) cases. Conclusions: A wide range of oculoplastic surgery conditions was managed virtually during the COVID-19 pandemic. Utilization of initial virtual visit versus follow-up care varied by diagnosis. Virtual visits may improve access to oculoplastic subspecialty care for patients from underserved areas.
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Affiliation(s)
| | - Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Paramo R, Zong AM, Barmettler A. Socioeconomic Disparities Associated with Access to Oculofacial Plastic Surgeons: A Cross-Sectional Analysis of US County Demographics. Ophthalmology 2024; 131:492-498. [PMID: 37852418 DOI: 10.1016/j.ophtha.2023.10.020] [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] [Received: 06/27/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To compare population demographics with the geographic distribution of oculofacial plastic surgeons (OPSs) in the United States. DESIGN A cross-sectional study design was used to investigate demographic differences between counties with 1 or more OPSs and counties with zero OPSs. PARTICIPANTS The number of OPSs were identified in each US county using online public databases: American Society of Ophthalmic Plastic and Reconstructive Surgeons and American Academy of Ophthalmology. Counties were categorized into 2 groups: 1 or more OPSs and zero OPSs. Demographic characteristics at the county level were obtained from the 2021 US Census Bureau Population Estimates and the American Community Survey. Cost of living was collected from the 2022 Economic Policy Institute Family Budget Calculator. MAIN OUTCOME MEASURES Socioeconomic demographics of the US population as related to geographic OPS distribution. RESULTS A total of 1238 OPSs were identified. States with the most OPSs per million were Hawaii (6.2), D.C. (6.0), Connecticut (5.8), Utah (5.1), and Maryland (5.0). Among 3143 counties, 2725 (86.7%) had zero OPSs and 418 (13.3%) had 1 or more OPSs. Counties with 1 or more OPSs had a higher median (standard deviation) household income versus counties with zero OPSs ($72 471 [$19 152] vs. $56 152 [$13 675]; difference $16 319; 95% confidence interval [CI], $14 300-$18 338; P < 0.001). The annual cost of living per person (standard deviation) was higher in counties with 1 or more OPSs versus counties with zero OPSs ($39 238 [$6992] vs. $36 227 [$3516]; difference $3011; 95% CI, $2328-$3694; P < 0.001). Counties with zero OPSs versus counties with 1 or more OPSs had higher proportions of persons with only Medicaid (15.6% vs. 13.6%; difference 2.0%; 95% CI, 1.4%-2.5%; P < 0.001), no health insurance (9.9% vs. 8.0%; difference 1.9%; 95% CI, 1.5%-2.4%; P < 0.001), no household internet access (17.2% vs. 9.6%; difference 7.6%; 95% CI, 7.1%-8.0%; P < 0.001), and higher proportions of persons aged 65 years or older (20.0% vs. 17.0%; difference 3.0%; 95% CI, 2.5%-3.5%; P < 0.001). CONCLUSIONS This cross-sectional analysis of all US counties revealed socioeconomic disparities associated with access to OPSs. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ricky Paramo
- Montefiore Medical Center, Department of Ophthalmology and Visual Sciences, Bronx, New York
| | - Amanda M Zong
- Albert Einstein College of Medicine, Bronx, New York
| | - Anne Barmettler
- Montefiore Medical Center, Department of Ophthalmology and Visual Sciences, Bronx, New York.
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3
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Schulz CB, Clarke H, Makuloluwe S, Thomas PB, Kang S. Automated extraction of clinical measures from videos of oculofacial disorders using machine learning: feasibility, validity and reliability. Eye (Lond) 2023; 37:2810-2816. [PMID: 36725916 PMCID: PMC9891656 DOI: 10.1038/s41433-023-02424-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/12/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To determine the feasibility, validity and reliability of automatically extracting clinically meaningful eyelid measurements from consumer-grade videos of individuals with oculofacial disorders. METHODS A custom computer program was designed to automatically extract clinical measures from consumer-grade videos. This program was applied to publicly available videos of individuals with oculofacial disorders, and age-matched controls. The primary outcomes were margin reflex distance 1 (MRD1) and 2 (MRD2), blink lagophthalmos, and ocular surface area exposure. Test-retest reliability was evaluated using Bland-Altman analysis to compare the agreement in obtained measures between separate videos of the same individual taken within 48 h of each other. RESULTS MRD1 was reduced in individuals with ptosis versus controls (2.2 mm versus 3.4 mm, p < 0.001), and increased in individuals with facial nerve palsy (FNP) (3.9 mm, p = 0.049) and thyroid eye disease (TED) (4.1 mm; p = 0.038). Blink lagophthalmos was increased in individuals with FNP (3.7 mm); p < 0.001) and those with TED (0.1 mm, p = 0.003) versus controls (0.0 mm). Ocular surface exposure was reduced in individuals with ptosis compared with controls (12.2 mm2 versus 13.1 mm2; p < 0.001) and increased in TED (13.7 mm2; p 0.002). Bland-Altmann analysis demonstrated 95% limits of agreement for video-derived measures: median MRD1: -1.1 to 1.1 mm; median MRD2: -0.9 to 1.0 mm; blink lagophthalmos: -3.5 to 3.7 mm; and average ocular surface area exposure: -1.6 to 1.6 mm2. CONCLUSIONS The presented program is capable of taking consumer grade videos of patients with oculofacial disease and providing clinically meaningful and reliable eyelid measurements that show promising validity.
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Affiliation(s)
| | - Holly Clarke
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Sarith Makuloluwe
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Peter B Thomas
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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4
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Fydanaki O, Kanwar T, Bhalla M, Rahimzadeh M, Ibrahim H, Jain R, Aziz A, Lee V. Video consultations in oculoplastic service: a continuing role post-pandemic? Eye (Lond) 2023; 37:2826-2827. [PMID: 36859598 PMCID: PMC9977082 DOI: 10.1038/s41433-023-02385-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/08/2022] [Accepted: 01/10/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
- Ourania Fydanaki
- Western Eye Hospital, Imperial College Healthcare Trust, 153-173 Marylebone Rd, London, NW1 5QH, UK
| | - Tavishi Kanwar
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Minak Bhalla
- Western Eye Hospital, Imperial College Healthcare Trust, 153-173 Marylebone Rd, London, NW1 5QH, UK
| | - Mana Rahimzadeh
- Western Eye Hospital, Imperial College Healthcare Trust, 153-173 Marylebone Rd, London, NW1 5QH, UK
| | - Hussein Ibrahim
- Western Eye Hospital, Imperial College Healthcare Trust, 153-173 Marylebone Rd, London, NW1 5QH, UK
| | - Rajni Jain
- Western Eye Hospital, Imperial College Healthcare Trust, 153-173 Marylebone Rd, London, NW1 5QH, UK
| | - Ahmad Aziz
- Western Eye Hospital, Imperial College Healthcare Trust, 153-173 Marylebone Rd, London, NW1 5QH, UK
| | - Vickie Lee
- Western Eye Hospital, Imperial College Healthcare Trust, 153-173 Marylebone Rd, London, NW1 5QH, UK.
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Valentim CCS, Muste JC, Iyer AI, Krause MA, Kalur A, Gendi SW, Ohlhausen M, Rachitskaya A, Singh RP, Talcott KE. Characterization of ophthalmology virtual visits during the COVID-19 pandemic. Eye (Lond) 2023; 37:332-337. [PMID: 35091708 PMCID: PMC8796604 DOI: 10.1038/s41433-022-01938-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/14/2021] [Accepted: 01/13/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To characterize the use of virtual visits, as well as compare the characteristics to in-person visits during the pandemic period. METHODS This retrospective study included patients who had virtual and in-person ophthalmology visits from March 19, 2020, to July 31, 2020, in a large multispecialty ophthalmic center. Exclusion criteria included patients aged less than 18 years old; canceled, incomplete, mislabelled, and duplicated visits. 2943 virtual and 56,174 in-person visits were identified. A random sample of 3000 in-person visits was created. Each visit was analyzed as an individual data point. RESULTS 2,266 virtual visits (2,049 patients, 64.3% female, mean [SD] age 64.3 [16.6] years old) and 2590 in-person visits (2509 patients, 59.5% female, 65.9 [15.8] years old) were included. Most virtual visits were classified as comprehensive ophthalmology (34.6%), optometry-related (19.5%), and oculoplastics (13.0%). For in-person visits, the most common specialties were optometry (29.8%), comprehensive ophthalmology (23.9%), and retina and uveitis (17.3%). The most common diagnoses in the virtual group were from the eyelids, lacrimal system, and orbits group (26.9%), while in the in-person groups were choroid and retina conditions (19.3%). CONCLUSIONS Numerous ocular conditions were evaluated and managed through virtual visits, and external complaints and oculoplastic consults appear to be well-suited to the virtual format. Further studies focusing on visual outcomes and patient experience will be beneficial.
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Affiliation(s)
- Carolina C. S. Valentim
- grid.239578.20000 0001 0675 4725Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH USA
| | - Justin C. Muste
- grid.239578.20000 0001 0675 4725Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH USA
| | - Amogh I. Iyer
- grid.239578.20000 0001 0675 4725Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH USA
| | - Michael A. Krause
- grid.239578.20000 0001 0675 4725Cole Eye Institute, Cleveland Clinic, Cleveland, OH USA
| | - Aneesha Kalur
- grid.239578.20000 0001 0675 4725Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH USA
| | - Steve W. Gendi
- grid.67105.350000 0001 2164 3847Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Marc Ohlhausen
- grid.67105.350000 0001 2164 3847Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Aleksandra Rachitskaya
- grid.239578.20000 0001 0675 4725Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH USA
| | - Rishi P. Singh
- grid.239578.20000 0001 0675 4725Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH USA
| | - Katherine E. Talcott
- grid.239578.20000 0001 0675 4725Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH USA
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Sundararajan M, Schallhorn JM, Doan T, Seitzman GD. Changes to ophthalmic clinical care during the coronavirus disease 2019 pandemic. Curr Opin Ophthalmol 2021; 32:561-566. [PMID: 34456291 PMCID: PMC8664232 DOI: 10.1097/icu.0000000000000797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Given the impact that society as a whole, and medicine specifically, has experienced as a result of the COVID-19 pandemic, an examination of clinical care changes enacted in the field of ophthalmology is of interest to the specialty. RECENT FINDINGS In order to adapt to the reality of the COVID-19 pandemic, measures, such as broadening telehealth capabilities, adopting universal masking, careful sanitation procedures, applying virtual teaching in academic environments, and deferring elective surgeries were put in place. These were aimed at reducing person-to-person spread of SARS-CoV-2. Though best efforts were made at triaging ophthalmic emergencies during these times, unfortunate delays in care were observed in some circumstances. Finally, a prospective study interrogating the risk of spread at slit lamp distances for short periods of time was encouraging, suggesting low risk of transmissibility, though limited by a small case-positive sample size. SUMMARY Significant changes have been made in the design and delivery of ophthalmic care during the COVID-19 pandemic. Some of these, such as telemedicine, may provide value in a postpandemic world.
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Affiliation(s)
- Miel Sundararajan
- Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Julie M. Schallhorn
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Thuy Doan
- Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Gerami D. Seitzman
- Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Lelli GJ, Luo S, Liu Y, van Landingham SW. Telemedicine Use by Oculoplastic Surgeons During the COVID-19 Pandemic. Telemed J E Health 2021; 28:878-887. [PMID: 34591712 DOI: 10.1089/tmj.2021.0307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Telemedicine use expanded dramatically during the COVID-19 pandemic, including to surgical fields that had limited prior adoption of telehealth such as oculoplastic surgery. To assess telemedicine usage patterns, barriers to implementation, and satisfaction with telemedicine, we conducted a survey among members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Methods: We performed a Web-based, anonymous survey of ASOPRS members from November to December 2020. Statistical analyses were performed by using Fisher's exact and Chi-squared tests. Results: We received 196 unique survey responses from 963 invited participants (20.5% response rate). Among the 192 ASOPRS members who participated, the majority (79%) reported currently using telemedicine. Very few of those currently using telemedicine (14%) had used telemedicine before March 15, 2020 and a significant proportion (36%) were unsure or did not plan to use telemedicine post-pandemic. Telemedicine use was more common among participants with fewer years in practice (p < 0.01) and those who were university- versus self-employed (p < 0.01). The most common barriers to telemedicine use were technological issues, reimbursement concerns, and a perceived lack of patient acceptance. Nearly half of the surgeons reported being satisfied with telemedicine (48%), and the majority reported perceived patient satisfaction with telemedicine (74%). Discussion: Telemedicine adoption increased significantly among oculoplastic surgeons during the COVID-19 pandemic. However, many current users reported that they were unsure or did not plan to use telemedicine post-pandemic. Conclusions: Further research is needed to design sustainable telemedicine programs to enhance patient access to oculoplastic specialty care in the long term.
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Affiliation(s)
- Gary J Lelli
- Weill Cornell Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Susan Luo
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Suzanne W van Landingham
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Ramessur R, Raja L, Kilduff CLS, Kang S, Li JPO, Thomas PBM, Sim DA. Impact and Challenges of Integrating Artificial Intelligence and Telemedicine into Clinical Ophthalmology. Asia Pac J Ophthalmol (Phila) 2021; 10:317-327. [PMID: 34383722 DOI: 10.1097/apo.0000000000000406] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT Aging populations and worsening burden of chronic, treatable disease is increasingly creating a global shortfall in ophthalmic care provision. Remote and automated systems carry the promise to expand the scale and potential of health care interventions, and reduce strain on health care services through safe, personalized, efficient, and cost-effective services. However, significant challenges remain. Forward planning in service design is paramount to safeguard patient safety, trust in digital services, data privacy, medico-legal implications, and digital exclusion. We explore the impact and challenges facing patients and clinicians in integrating AI and telemedicine into ophthalmic care-and how these may influence its direction.
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Affiliation(s)
- Rishi Ramessur
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Laxmi Raja
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline L S Kilduff
- Central Middlesex Hospital, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Ji-Peng Olivia Li
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter B M Thomas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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9
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Kang S, Raja L, Sim DA, Thomas PBM, Ezra DG. Telemedicine in oculoplastic and adnexal surgery: clinicians' perspectives in the UK. Br J Ophthalmol 2021; 106:1344-1349. [PMID: 33910884 DOI: 10.1136/bjophthalmol-2020-318696] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS The COVID-19 has facilitated a paradigm shift in the sphere of ophthalmic telemedicine: its utility is no longer limited to providing care to remote regions, rather it is expeditiously being adopted as the new standard of care. The aim of our paper is to explore the current attitudes of oculoplastic surgeons towards telemedicine and its utility in the present landscape and its prospects in the future. METHODS A 39-item questionnaire was distributed to consultant oculoplastic surgeons practising across the UK and anonymised responses were collected and analysed. RESULTS The COVID-19 pandemic has allowed rapid implementation of telemedicine services in oculoplastic departments across the UK with 86.6% of the respondents incorporating telemedicine into the routine clinical practice. Clinicians reported a statistically significant increase in utility of telemedicine, confidence in using telemedicine and quality of infrastructure available to employ telemedicine following the COVID-19 outbreak. The greatest utility of telemedicine is in triaging, postoperative assessment and eyelid lesion assessment. Main barriers to implementation of telemedicine included difficulties in conducting clinical examinations, lack of administrative support and poor access to digital technologies for patients. Overall, most clinicians were satisfied with the impact of telemedicine services and almost all experts foresee themselves continuing to use telemedicine in the future. CONCLUSIONS Telemedicine has become an integral part of the oculoplastic service delivery since the COVID-19 pandemic its use is likely to continue. Further development of digital infrastructure and improvement of clinical examination capabilities are required to enable its wider adoption.
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Affiliation(s)
- Swan Kang
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK .,Department of Digital Medicine, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Laxmi Raja
- Department of Digital Medicine, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dawn A Sim
- Department of Digital Medicine, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,NIHR Moorfields Biomedical Research Centre, London, UK
| | - Peter B M Thomas
- Department of Digital Medicine, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,NIHR Moorfields Biomedical Research Centre, London, UK
| | - Daniel G Ezra
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,NIHR Moorfields Biomedical Research Centre, London, UK
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10
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Kang S, Dehabadi M, Sim DA, Thomas PBM, Appiah Ewusi D, Ezra D. Accuracy of periocular lesion assessment using telemedicine. BMJ Health Care Inform 2021; 28:bmjhci-2020-100287. [PMID: 33483345 PMCID: PMC7831705 DOI: 10.1136/bmjhci-2020-100287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 11/11/2022] Open
Abstract
Objectives To assess the agreement in diagnosis and management plans reached between clinicians reviewing eyelid lesions remotely and in face-to-face clinics. Methods In this single-centre observational case series, data were prospectively collected on 50 consecutive adults referred with eyelid lesions suitable to be seen by a nurse. A proforma was completed to gather salient information. A nurse specialist saw patients in face-to-face clinics and collected information using the proforma, devising a diagnosis and management plan. Photographs of the eyelid lesions were taken by a medical photographer. A subsequent remote review was completed by an oculoplastic consultant using the proforma information and photographs in the absence of the patient. The diagnosis and management plan constructed by the nurse specialist were compared with those reached by the consultant. Results Complete data were available for 44 consecutive cases. There was an overall 91% agreement (40 cases out of 44) between the diagnoses reached by the nurse specialist, and the remote reviewer; kappa coefficient 0.88 (95% CI 0.76 to 0.99). There was an overall 82% agreement (36 out of 44 cases) in the management plans devised by the nurse-led clinic and remote reviewer; kappa coefficient 0.74 (95% CI 0.58 to 0.90). The average time taken for a remote reviewer to reach a diagnosis and management plan was 1 min and 20 s. Conclusions This study evaluated the feasibility of assessing eyelid lesions using asynchronous telemedicine. There was overall a high rate of concordance in the diagnosis reached, and management devised between the clinic and remote review.
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Affiliation(s)
- Swan Kang
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mohammad Dehabadi
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Peter B M Thomas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Doris Appiah Ewusi
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Daniel Ezra
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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