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Balakrishnan P, Swain TA, McGwin G, Owsley C, Girkin CA, Rhodes LA. Comparison of Glaucoma Diagnosis by Telemedicine, In-Person Ophthalmologist, and Optometrist. J Glaucoma 2024; 33:619-623. [PMID: 38976298 PMCID: PMC11365792 DOI: 10.1097/ijg.0000000000002456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/15/2024] [Indexed: 07/09/2024]
Abstract
PRCIS Diagnosis of glaucoma through telemedicine demonstrates moderate agreement with in-person ophthalmologist (MD) and in-person optometrist (OD) diagnosis, providing evidence that telemedicine is a timely, accurate screening method in settings where an in-person visit may not be feasible. OBJECTIVE To compare diagnostic agreement of glaucoma between in-person MD, in-person OD, and a simulated telemedicine program. PATIENTS AND METHODS A cross-sectional study of patients with normal optic nerve structural and functional imaging and new patients referred for glaucoma evaluation examined in-person by an MD for glaucoma with a dilated examination and structural and functional optic nerve testing (optical coherence tomography, photos, and visual field); examined in person by an OD with a dilated examination and optic nerve testing; and structural and functional optic nerve testing reviewed separately by 2 ophthalmologists [telemedicine ophthalmologist reviewer 1 (TMD1), telemedicine ophthalmologist reviewer 2 (TMD2)] with masking of prior MD and OD diagnoses. Interrater agreement between each diagnostic method (MD, OD, TMD1, and TMD2) of normal versus disease (open angle glaucoma, normal tension glaucoma, other types of glaucoma, other optic nerve disorders, ocular hypertension, and glaucoma suspect) for each eye was calculated (Cohen unweighted kappa). RESULTS A total of 100 patients with a median age of 66 years (interquartile range: 59-72), male (40%) and white (62%) were analyzed. There was moderate agreement between MD and telemedicine [TMD1 kappa 0.49 (95% CI: 0.37-0.61), TMD2 kappa 0.44 (95% CI: 0.32-0.56)] and between MD and OD diagnosis [0.41 (95% CI: 0.28-0.54)] and fair-moderate agreement between OD and telemedicine [TMD1: 0.46 (95% CI: 0.34-0.58), TMD2: 0.61 (95% CI: 0.50-0.72)]. CONCLUSIONS The simulated telemedicine approach had comparable levels of agreement in glaucoma diagnosis with in-person fellowship-trained ophthalmologists, presenting a crucial complementary role in screening and increasing access to care, particularly in rural or underserved settings.
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Affiliation(s)
- Poojitha Balakrishnan
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas A. Swain
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher A. Girkin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lindsay A. Rhodes
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Gobira M, Freire V, de Aquino GSA, Dib V, Gobira M, Carricondo PC, Dias A, Negreiros MA. Evaluating the precision of an online visual acuity test tool. J Telemed Telecare 2024:1357633X241252454. [PMID: 38766707 DOI: 10.1177/1357633x241252454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE The aim of this study was to assess the precision of a web-based tool in measuring visual acuity (VA) in ophthalmic patients, comparing it to the traditional in-clinic evaluation using a Snellen chart, considered the gold standard. METHODS We conducted a prospective and in-clinic validation comparing the Eyecare Visual Acuity Test® to the standard Snellen chart, with patients undergoing both tests sequentially. Patients wore their standard spectacles as needed for both tests. Inclusion criteria involved individuals above 18 years with VA equal to or better than +1 logMar (20/200) in each eye. VA measurements were converted from Snellen to logMAR, and statistical analyses included Bland-Altman and descriptive statistics. RESULTS The study, encompassing 322 patients and 644 eyes, compared Eyecare Visual Acuity Test® to conventional methods, revealing a statistically insignificant mean difference (0.01 logMAR, P = 0.1517). Bland-Altman analysis showed a narrow 95% limit of agreement (0.22 to -0.23 logMAR), indicating concordance, supported by a significant Pearson correlation (r = 0.61, P < 0.001) between the two assessments. CONCLUSION The Eyecare Visual Acuity Test® demonstrates accuracy and reliability, with the potential to facilitate home monitoring, triage, and remote consultation. In future research, it is important to validate the Eyecare Visual Acuity Test® accuracy across varied age cohorts, including pediatric and geriatric populations, as well as among individuals presenting with specific comorbidities like cataract, uveitis, keratoconus, age-related macular disease, and amblyopia.
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Affiliation(s)
- Mauro Gobira
- Department of Ophthalmology, Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), São Paulo, SP, Brazil
- Department of Ophthalmology, Eyecare Health Company, São Paulo, SP, Brazil
| | - Vinícius Freire
- Department of Ophthalmology, Universidade São Paulo (USP), São Paulo, SP, Brazil
| | | | - Vanessa Dib
- Department of Ophthalmology, Hospital Evangélico de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Matheus Gobira
- Department of Ophthalmology, Faculdade de Minas (FAMINAS), Belo Horizonte, MG, Brazil
| | | | - Ariadne Dias
- Department of Ophthalmology, Eyecare Health Company, São Paulo, SP, Brazil
| | - Marco Antonio Negreiros
- Department of Ophthalmology, Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), São Paulo, SP, Brazil
- Department of Ophthalmology, Eyecare Health Company, São Paulo, SP, Brazil
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Joseph S, Rajendran VK, Khetwani D, Uduman MS, Ramasamy D, Gowth AM, Kowsalya A, Ehrlich JR, Ravilla TD. Evaluation of a telemedicine-enabled universal eye health delivery model in rural southern India. Eye (Lond) 2024; 38:1202-1207. [PMID: 38057562 PMCID: PMC11009233 DOI: 10.1038/s41433-023-02871-8] [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: 04/22/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES To evaluate the accuracy of tele-ophthalmic examination (TOE) for common ocular conditions in comparison with the gold-standard in-person examination (IPE) for diagnosis and treatment advice. METHODS In a prospective, diagnostic accuracy validation study, we recruited 339 consecutive new patients, aged ≥16 years, visiting a vision centre (VC) associated with Aravind Eye Hospital in south India during January and February, 2020. All participants underwent the TOE, followed by IPE on the same visit. The in-person ophthalmologist was masked to the TOE diagnosis and treatment advice. Data were analysed via the sensitivity specificity of TOE versus the gold-standard IPE. RESULTS TOE achieved high sensitivity and specificity for identifying normal eyes with 87.4% and 93.5%, respectively. TOE had high sensitivity for cataracts (91.7%), infective conjunctivitis (72.2%), and moderate sensitivity for pterygium (62.5%), DR (57.1%), non-serious injury (41.7%), but low sensitivity for glaucoma (12.5%). TOE had high specificity ranging from 93.5% to 99.8% for all diagnoses. The sensitivity for treatment advice ranged from 58.1% to 77.2% and specificity from 96.9% to 100%. CONCLUSIONS The TOE in VCs has acceptable accuracy to an IPE by an ophthalmologist for correctly identifying and treating major eye ailments. Through providing universal eye care to rural populations, this model may contribute to work toward achieving Universal Health Coverage, which is a linchpin of the health-related U.N. Sustainable Development Goals (SDG).
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Affiliation(s)
- Sanil Joseph
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Vinoth Kumar Rajendran
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Dhwanit Khetwani
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
| | | | - Dhivya Ramasamy
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | | | - Akkayasamy Kowsalya
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, USA
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Thulasiraj D Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India.
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Bhatnagar A, Skrehot H, Ahmed M. COUNTY-LEVEL ANALYSIS OF EYE EXAM ACCESS AND UTILIZATION IN THE UNITED STATES. Ophthalmic Epidemiol 2024; 31:152-158. [PMID: 37227243 DOI: 10.1080/09286586.2023.2216286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE The eye exam is a critical tool for the prevention, screening, and diagnosis of ocular and systemic conditions. In this study, we characterize county-level variation in eye exam access and utilization for Medicare patients in the United States. METHODS This nationwide study uses the Medicare Physician & Other Practitioners - by Provider and Service dataset. We included all ophthalmologists and optometrists who performed eye exams on Medicare beneficiaries within a United States county in 2019. For every county where exams were performed, we calculated the number of practicing vision testing providers, percentage of providers classified as ophthalmologists, and the number of exams per 100 Medicare beneficiaries. Multiple linear regression was used to characterize associations between these variables and county characteristics, including measures of poverty, education, and income. RESULTS In 2019, 28937,540 eye exams were performed by 46,000 providers in 2,291 U.S. counties. In the median county, 34.9 eye exams were provided per 100 Medicare beneficiaries. The average county had 20.1 exam providers, 16.5% of whom were ophthalmologists. There were a median 6.6 eye exam providers for every 10,000 Medicare beneficiaries in the average county. The average provider performed 517.8 exams. Regression showed counties with lower median household incomes, higher poverty rates, or fewer high-school graduates had fewer eye exam providers per 10,000 Medicare beneficiaries and fewer eye exams performed per 100 Medicare beneficiaries. CONCLUSIONS We find significant county-level variation in eye exam utilization and provider availability. This reflects broader, well-recognized trends in socioeconomic health disparities in the U.S.
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Affiliation(s)
- Anshul Bhatnagar
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Henry Skrehot
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Masih Ahmed
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA
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Guerrier G, Ohayon J, Rothschild PR, Baillard C. Is it safe to use telephone for anaesthesia consultation in high-risk patients before non-invasive surgery? A pilot study in ophthalmology. J Telemed Telecare 2024:1357633X231222661. [PMID: 38280210 DOI: 10.1177/1357633x231222661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Although telemedicine with video support for preoperative evaluation has been found effective, there is limited research on anaesthesia consultation by phone without video support, particularly among high-risk patients. To evaluate the effectiveness, safety and potential benefits of performing pre-anaesthesia evaluation by phone before eye surgery in patients having non-invasive surgery, we performed an observational study in a French teaching hospital. METHOD All elective patients having elective ophthalmic surgery were included to have a consultation by phone instead of an in-person consultation, regardless of the type of anaesthesia or ASA score. The incidence of day-of-surgery cancellations, patient satisfaction and time/distance saved through phone consultations were assessed. RESULTS From February to October 2022, data of 3480 patients were analyzed, including 370 (11%) high-risk patients (ASA 3-4). Anaesthesia-related day-of-surgery cancellation rate was 0.5% (n = 20) due to non-compliance with pre-operative instructions. No cancellation was due to inadequate pre-operative evaluation. No difference in cancellation rate was observed between low-risk patients and high-risk patients. Telephone consultations saved patients a mean of 126 min and 86 km. A younger age, an active status and living far from the hospital were associated with phone consultation preference. CONCLUSION Phone anaesthesia consultation seems to be effective and safe before ophthalmic surgery, regardless of patient's perioperative risk. In addition, phone consultation provides significant time and distance savings. Our results must be confirmed through a multicentric randomised study comparing phone and traditional consultation in ophthalmology as well as in other non-invasive surgical procedures in a high-risk patients population.
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Affiliation(s)
- Gilles Guerrier
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Centre de Recherche des Cordeliers, INSERM, Paris, France
| | - Johanna Ohayon
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre-Raphaël Rothschild
- Université de Paris, Centre de Recherche des Cordeliers, INSERM, Paris, France
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Baillard
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
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Meer E, Grob SR, Lehnhardt K, Sawyer A. Ocular complaints and diagnoses in spaceflight. NPJ Microgravity 2024; 10:1. [PMID: 38167407 PMCID: PMC10762130 DOI: 10.1038/s41526-023-00335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024] Open
Abstract
The NASA human system risk board (HSRB) has long focused on trauma and acute medical illness as a key contributor to high level in-flight medical risk. However, ocular issues, trauma, and complaints during spaceflight are poorly characterized. In a retrospective case series, the NASA data from the life sciences data archieve (LSDA) and the lifetime surveillance of astronaught health (LSAH) was queried for eye related complaints and conditions in spaceflight across international space station (ISS) missions and space shuttle (STS) missions. The ISS dataset included missions from the year 2000 to 2020, and the STS dataset included missions from 1981 to 2011. Data were reviewed and segmented into categories of ocular complaints. 135 STS missions and 63 ISS missions were included in this analysis. Ocular events were only noted across 83 STS missions (61.5%) and 41 ISS missions (65.1%). Overall, the most common ocular complaints were eye irritation (n = 80, 33.1%), ocular foreign body or foreign body sensation (n = 55, 22.7%), dry eye syndromes (n = 38, 15.7%), epiphora or excessive tearing (n = 19, 7.85%). Of all ocular complaints or diagnoses, 9 (3.72%) were considered higher severity (keratitis, corneal ulcer, chemical exposure, and corneal abrasion). However, seemingly none required evacuation from mission. Improved depiction of ocular symptoms and diagnoses, and a more standard classification system and process to describe ocular symptoms, diagnoses, and treatments in space is crucial to provide more effective and comprehensive treatments.
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Affiliation(s)
- Elana Meer
- Wayne and Gladys Valley Center for Vision, Department of Ophthalmology, University of California, San Francisco, CA, USA.
- University of California Space Health Program, San Francisco, CA, USA.
| | - Seanna R Grob
- Wayne and Gladys Valley Center for Vision, Department of Ophthalmology, University of California, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Wayne and Gladys Valley Center for Vision, Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Kris Lehnhardt
- Exploration Medical Capability, NASA Johnson Space Center, Houston, TX, USA
| | - Aenor Sawyer
- University of California Space Health Program, San Francisco, CA, USA
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
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Iorio-Aranha F, de Freitas C, Rocha-Sousa A, Azevedo A, Barbosa-Breda J. Nationwide consensus on quality indicators to assess glaucoma care: A modified Delphi approach. Eur J Ophthalmol 2024; 34:217-225. [PMID: 37069806 PMCID: PMC10757386 DOI: 10.1177/11206721231170033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Performance assessments are essential to tracking and improving quality in health care systems. Key aspects of the care process that act as indicators must be measured in order to gain an in-depth understanding of a care unit's operation. Without standardized quality indicators (QIs), it is difficult to characterize and compare the abilities of institutions to achieve excellence. The aim of this study is to reach a consensus among glaucoma specialists concerning the development of a set of QIs to assess the performance of glaucoma care units. METHODS A two-round Delphi technique was performed among glaucoma specialists in Portugal, using a 7-point Likert scale. Fifty-three initial statements (comprising process, structure, and outcome indicators) were evaluated and participants had to agree on which ones would be part of the final set of QIs. RESULTS By the end of both rounds, 28 glaucoma specialists reached consensus on 30/53 (57%) statements, including 19 (63%) process indicators (mainly relating to the proper implementation of complementary exams and the setting of follow-up intervals), 6 (20%) structure indicators, and 5 (17%) outcome indicators. Of the indicators that were part of the final list, functional and structural aspects of glaucoma progression and the availability of surgical/laser procedures were the most prevalent. CONCLUSIONS A set of 30 QIs for measuring the performance of glaucoma units was developed using a consensus methodology involving experts in the field. Their use as measurement standards would provide important information about unit operations and allow further implementation of quality improvements.
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Affiliation(s)
- Flavio Iorio-Aranha
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Ophthalmology, Faculty of Medicine, Universidade de Brasilia, Brasilia, Brasil
| | - Cláudia de Freitas
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- UnIC@RISE, Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana Azevedo
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Hospital Epidemiology Center, Centro Hospitalar Universitário São João, Porto, Portugal
| | - João Barbosa-Breda
- UnIC@RISE, Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Neurosciences, KULeuven, Research Group Ophthalmology, Leuven, Belgium
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Huther A, Roh S, Ramsey DJ. Telehealth improves follow-up and monitoring of age-related macular degeneration during the COVID-19 pandemic. Int Ophthalmol 2023; 43:5031-5043. [PMID: 37921948 DOI: 10.1007/s10792-023-02906-9] [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: 04/21/2022] [Accepted: 09/28/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE To prevent vision loss, it is important to monitor patients with age-related macular degeneration (AMD) for the development of choroidal neovascularization. The coronavirus disease 2019 (COVID-19) pandemic caused many patients to miss or delay visits. To offset those gaps in care, providers utilized telehealth (TH) to evaluate patients for symptoms of disease progression and provide health education on the importance of continuous monitoring. METHODS This study evaluates the impact of TH encounters on the rate of return for recommended in-person examinations for 1103 patients with non-neovascular (dry) AMD seen in an outpatient ophthalmology clinic in 2019 and due for return evaluation after the outbreak of COVID-19 in 2020. Logistic regression analysis was used to identify demographic, clinical, and sociomedical factors associated with TH utilization and in-person return. RESULTS 422 patients (38%) utilized TH during the study period. Patients who completed a TH encounter were more likely to return for an in-person examination as compared with those who did not receive TH (OR: 1.8, CI 95%: 1.4-2.3, P < 0.001). Completing a TH visit was associated with the detection of new wet AMD (OR: 3.3, 95% CI 1.04-10.6, P = 0.043), as well as with an earlier return for those patients who were found to have disease progression (62 ± 54 days vs. 100 ± 57 days, P = 0.049). CONCLUSION Completing a TH visit increased the rate at which patients with dry AMD returned for recommended in-person eye examinations. In many cases, this permitted the earlier detection of wet AMD, which is linked with achieving better outcomes.
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Affiliation(s)
- Alexander Huther
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA, 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Shiyoung Roh
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA, 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - David J Ramsey
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA, 01960, USA.
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA.
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Tan TF, Thirunavukarasu AJ, Jin L, Lim J, Poh S, Teo ZL, Ang M, Chan RVP, Ong J, Turner A, Karlström J, Wong TY, Stern J, Ting DSW. Artificial intelligence and digital health in global eye health: opportunities and challenges. Lancet Glob Health 2023; 11:e1432-e1443. [PMID: 37591589 DOI: 10.1016/s2214-109x(23)00323-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
Global eye health is defined as the degree to which vision, ocular health, and function are maximised worldwide, thereby optimising overall wellbeing and quality of life. Improving eye health is a global priority as a key to unlocking human potential by reducing the morbidity burden of disease, increasing productivity, and supporting access to education. Although extraordinary progress fuelled by global eye health initiatives has been made over the last decade, there remain substantial challenges impeding further progress. The accelerated development of digital health and artificial intelligence (AI) applications provides an opportunity to transform eye health, from facilitating and increasing access to eye care to supporting clinical decision making with an objective, data-driven approach. Here, we explore the opportunities and challenges presented by digital health and AI in global eye health and describe how these technologies could be leveraged to improve global eye health. AI, telehealth, and emerging technologies have great potential, but require specific work to overcome barriers to implementation. We suggest that a global digital eye health task force could facilitate coordination of funding, infrastructural development, and democratisation of AI and digital health to drive progress forwards in this domain.
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Affiliation(s)
- Ting Fang Tan
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Arun J Thirunavukarasu
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Corpus Christi College, University of Cambridge, Cambridge, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Liyuan Jin
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Joshua Lim
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Stanley Poh
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Zhen Ling Teo
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - R V Paul Chan
- Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Urbana-Champaign, IL, USA
| | - Jasmine Ong
- Pharmacy Department, Singapore General Hospital, Singapore
| | - Angus Turner
- Lions Eye Institute, University of Western Australia, Nedlands, WA, Australia
| | - Jonas Karlström
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore General Hospital, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Jude Stern
- The International Agency for the Prevention of Blindness, London, UK
| | - Daniel Shu-Wei Ting
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
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Liu H, Ying S, Kamat S, Tukel C, Serle J, Fallar R, Tai TYT, Chadha N. The Role of Telemedicine in Glaucoma Care Triggered by the SARS-CoV-2 Pandemic: A Qualitative Study. Clin Ophthalmol 2023; 17:2251-2266. [PMID: 37575208 PMCID: PMC10422957 DOI: 10.2147/opth.s418502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To explore and report on how glaucoma care was impacted by the SARS-CoV-2 pandemic (COVID-19) in New York City (NYC) with a specific emphasis on the role of telemedicine. Patients and Methods This was a qualitative, cross-sectional study that engaged glaucoma clinicians in semi-structured interviews to elicit perspectives on telemedicine and patient care experiences during the pandemic. Interview responses were coded and analyzed thematically. Results Twenty clinicians participated. Mean participant age was 48.8 ± 12.3 years, and the mean number of years in practice post-glaucoma fellowship was 17.5 ± 12.4 years. Four main themes pertinent to the role of telemedicine triggered by the COVID-19 pandemic were identified: (1) The Need to Ensure Patient and Staff Safety Drove Telemedicine Uptake; (2) Telemedicine Allowed Providers to Address Subjective Complaints; (3) Telemedicine was Discontinued Due To Concerns of Compromised Patient Safety and Measurement Inaccuracy; (4) Technological Advances are Needed for Continued Telemedicine Usage and Uptake in Glaucoma Care. The interviews suggested that telemedicine usage dropped markedly within just a few months during the pandemic, and for most physicians interviewed, telemedicine is no longer part of their clinical practice. Several clinicians reported optimism towards future implementation of telemedicine as the technology develops. Conclusion This study identified 4 themes outlining the uptake, application, discontinuation and overall perspectives on telemedicine by glaucoma clinicians. The role of telemedicine, as triggered by the COVID-19 pandemic, may have lasting implications for patient safety, continuity of care, and glaucoma care delivery beyond this public health crisis.
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Affiliation(s)
- Helen Liu
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephanie Ying
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samir Kamat
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Connor Tukel
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janet Serle
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | - Robert Fallar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tak Yee Tania Tai
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
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11
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Shah Z, Shroff U, Gajiwala U, Shamanna BR. A technological approach to "Reaching the Unreached" - Leveraging teleophthalmology services in Rural Gujarat. Indian J Ophthalmol 2023; 71:2995-3000. [PMID: 37530271 PMCID: PMC10538850 DOI: 10.4103/ijo.ijo_3010_22] [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: 11/14/2022] [Revised: 04/22/2023] [Accepted: 05/30/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose Early detection of sight-threatening disorders by technological applications like teleophthalmology and prompt treatment can help decrease visual impairment. This study evaluated the role of teleophthalmology in underserved rural areas along with cost-saving estimates for the end user. Methods A prospective, observational, cross-sectional hospital-based study was conducted over 3 months. First 1000 teleconsultations were included. None of the patients denied providing informed consent. The patients were consulted at the eight vision centers and three satellite centers of the hospital in the nearby rural and tribal regions closer to their residential places. These vision and satellite centers were connected to the base hospital like a hub and spoke model with a teleophthalmology network. Results Cataract (n = 301, 30.1%) and refractive error (n = 290, 29%) were the most common diagnosis. 42.1% of patients were referred to base hospital for further evaluation. Thus, a total of 57.9% of patients were not required to visit the base hospital for initial consultation, saving time and money. Furthermore, 15.1% of patients were provided medical treatment at the vision center and satellite center, which helped in making teleophthalmology cost-saving for the patients. An average of Rs. 621/- were saved per patient for the community in our study. Conclusion Networked teleophthalmology model can be an affordable and feasible tool for providing eye care delivery services in rural and tribal regions of Gujarat and the whole country, especially for the end user. Thus, it may be a workable model in ophthalmology practice with substantial cost saving to the community.
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Affiliation(s)
- Zalak Shah
- Department of General Ophthalmology, Comprehensive Ophthalmology Fellow, Gujarat, India
| | - Uma Shroff
- Paediatric Ophthalmology Department, Pediatric Ophthalmologist and Anterior Segment Surgeon, Gujarat, India
| | - Uday Gajiwala
- Department of Community Ophthalmology, Superintendent, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Surat, Gujarat, India
| | - B R Shamanna
- Department of Public health, School of Medical Science, University of Hyderabad, Hyderabad, Telangana, India
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12
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Thirunavukarasu AJ, Hassan R, Limonard A, Savant SV. Accuracy and reliability of self-administered visual acuity tests: Systematic review of pragmatic trials. PLoS One 2023; 18:e0281847. [PMID: 37347757 PMCID: PMC10286971 DOI: 10.1371/journal.pone.0281847] [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: 02/01/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Remote self-administered visual acuity (VA) tests have the potential to allow patients and non-specialists to assess vision without eye health professional input. Validation in pragmatic trials is necessary to demonstrate the accuracy and reliability of tests in relevant settings to justify deployment. Here, published pragmatic trials of these tests were synthesised to summarise the effectiveness of available options and appraise the quality of their supporting evidence. METHODS A systematic review was undertaken in accordance with a preregistered protocol (CRD42022385045). The Cochrane Library, Embase, MEDLINE, and Scopus were searched. Screening was conducted according to the following criteria: (1) English language; (2) primary research article; (3) visual acuity test conducted out of eye clinic; (4) no clinical administration of remote test; (5) accuracy or reliability of remote test analysed. There were no restrictions on trial participants. Quality assessment was conducted with QUADAS-2. RESULTS Of 1227 identified reports, 10 studies were ultimately included. One study was at high risk of bias and two studies exhibited concerning features of bias; all studies were applicable. Three trials-of DigiVis, iSight Professional, and Peek Acuity-from two studies suggested that accuracy of the remote tests is comparable to clinical assessment. All other trials exhibited inferior accuracy, including conflicting results from a pooled study of iSight Professional and Peek Acuity. Two studies evaluated test-retest agreement-one trial provided evidence that DigiVis is as reliable as clinical assessment. The three most accurate tests required access to digital devices. Reporting was inconsistent and often incomplete, particularly with regards to describing methods and conducting statistical analysis. CONCLUSIONS Remote self-administered VA tests appear promising, but further pragmatic trials are indicated to justify deployment in carefully defined contexts to facilitate patient or non-specialist led assessment. Deployment could augment teleophthalmology, non-specialist eye assessment, pre-consultation triage, and autonomous long-term monitoring of vision.
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Affiliation(s)
- Arun James Thirunavukarasu
- School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom
- Corpus Christi College, University of Cambridge, Cambridge, United Kingdom
| | - Refaat Hassan
- School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom
- Sidney Sussex College, University of Cambridge, Cambridge, United Kingdom
| | - Aaron Limonard
- School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom
- St John’s College, University of Cambridge, Cambridge, United Kingdom
| | - Shalom Vitreous Savant
- School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom
- St John’s College, University of Cambridge, Cambridge, United Kingdom
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13
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Constantin A, Atkinson M, Bernabeu MO, Buckmaster F, Dhillon B, McTrusty A, Strang N, Williams R. Optometrists' Perspectives Regarding Artificial Intelligence Aids and Contributing Retinal Images to a Repository: Web-Based Interview Study. JMIR Hum Factors 2023; 10:e40887. [PMID: 37227761 DOI: 10.2196/40887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/23/2023] [Accepted: 04/19/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND A repository of retinal images for research is being established in Scotland. It will permit researchers to validate, tune, and refine artificial intelligence (AI) decision-support algorithms to accelerate safe deployment in Scottish optometry and beyond. Research demonstrates the potential of AI systems in optometry and ophthalmology, though they are not yet widely adopted. OBJECTIVE In this study, 18 optometrists were interviewed to (1) identify their expectations and concerns about the national image research repository and their use of AI decision support and (2) gather their suggestions for improving eye health care. The goal was to clarify attitudes among optometrists delivering primary eye care with respect to contributing their patients' images and to using AI assistance. These attitudes are less well studied in primary care contexts. Five ophthalmologists were interviewed to discover their interactions with optometrists. METHODS Between March and August 2021, 23 semistructured interviews were conducted online lasting for 30-60 minutes. Transcribed and pseudonymized recordings were analyzed using thematic analysis. RESULTS All optometrists supported contributing retinal images to form an extensive and long-running research repository. Our main findings are summarized as follows. Optometrists were willing to share images of their patients' eyes but expressed concern about technical difficulties, lack of standardization, and the effort involved. Those interviewed thought that sharing digital images would improve collaboration between optometrists and ophthalmologists, for example, during referral to secondary health care. Optometrists welcomed an expanded primary care role in diagnosis and management of diseases by exploiting new technologies and anticipated significant health benefits. Optometrists welcomed AI assistance but insisted that it should not reduce their role and responsibilities. CONCLUSIONS Our investigation focusing on optometrists is novel because most similar studies on AI assistance were performed in hospital settings. Our findings are consistent with those of studies with professionals in ophthalmology and other medical disciplines: showing near universal willingness to use AI to improve health care, alongside concerns over training, costs, responsibilities, skill retention, data sharing, and disruptions to professional practices. Our study on optometrists' willingness to contribute images to a research repository introduces a new aspect; they hope that a digital image sharing infrastructure will facilitate service integration.
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Affiliation(s)
- Aurora Constantin
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Malcolm Atkinson
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Miguel Oscar Bernabeu
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona Buckmaster
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Alice McTrusty
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Robin Williams
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
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14
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Hennein L, Jastrzembski B, Shah AS. Use of Telemedicine in Pediatric Ophthalmology in the Underserved Population. Semin Ophthalmol 2023; 38:116-123. [PMID: 36529958 DOI: 10.1080/08820538.2022.2152703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Access to pediatric eye care is critical in diagnosing and treating eye disease promptly to prevent visual impairment. The demand for pediatric ophthalmology is high, even in developed countries, and significant socioeconomic disparities exist in access to care. The purpose of this article is to summarize the current literature on the use of telemedicine in pediatric ophthalmology in the underserved population and to identify areas of opportunity. A detailed literature review was performed in PubMed and Google Scholar on October 1, 2021. All articles in English that described the use of telemedicine in pediatric ophthalmology, with particular attention to the underserved pediatric population, were included. There is a paucity of literature on the visual outcomes from pediatric teleophthalmology alone, and even less in underserved populations specifically. Literature supports its use in subacute to chronic eye disease, return and postoperative visits, and screening for retinopathy in prematurity in particular. Collaboration between pediatric optometrists and pediatric ophthalmologists for both asynchronous and synchronous care delivery models has shown promise in several studies. It is essential to operate within the limits of pediatric teleophthalmology and utilize this valuable service for its strengths. Telemedicine may expand access to pediatric ophthalmologists in underserved populations and may reduce the burden of eye disease.
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Affiliation(s)
- Lauren Hennein
- Departments of Ophthalmology, Boston Children's Hospital, Massachusetts Eye & Ear, and Harvard Medical School, Boston, MA, USA
| | - Benjamin Jastrzembski
- Departments of Ophthalmology, Boston Children's Hospital, Massachusetts Eye & Ear, and Harvard Medical School, Boston, MA, USA
| | - Ankoor S Shah
- Departments of Ophthalmology, Boston Children's Hospital, Massachusetts Eye & Ear, and Harvard Medical School, Boston, MA, USA
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15
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Stamenova V, Nguyen M, Onabajo N, Merritt R, Sutakovic O, Mossman K, Wong I, Ives-Baine L, Bhatia RS, Brent MH, Bhattacharyya O. Mailed Letter Versus Phone Call to Increase Diabetic-Related Retinopathy Screening Engagement by Patients in a Team-Based Primary Care Practice: Prospective, Single-Masked, Randomized Trial. J Med Internet Res 2023; 25:e37867. [PMID: 36630160 PMCID: PMC9878360 DOI: 10.2196/37867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/13/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Vision loss from diabetic-related retinopathy (DR) is preventable through regular screening. OBJECTIVE The purpose of this study was to test different patient engagement approaches to expand a teleophthalmology program at a primary care clinic in the city of Toronto, Canada. METHODS A teleophthalmology program was set up in a large, urban, academic, team-based primary care practice. Patients older than 18 years with type 1 or type 2 diabetes were randomized to one of the following 4 engagement strategies: phone call, mail, mail plus phone call, or usual care. Outreach was conducted by administrative staff within the clinic. The primary outcome was booking an appointment for DR screening. RESULTS A total of 23 patients in the phone, 28 in the mail, 32 in the mail plus phone call, and 27 in the control (usual care) group were included in the analysis. After the intervention and after excluding patients who said they were screened, 88% (15/17) of patients in the phone, 11% (2/18) in the mail, and 100% (21/21) in the mail and phone group booked an appointment with the teleophthalmology program compared to 0% (0/12) in the control group. Phoning patients positively predicted patients booking a teleophthalmology appointment (P<.001), whereas mailing a letter had no effect. CONCLUSIONS Patient engagement to book DR screening via teleophthalmology in an urban, academic, team-based primary care practice using telephone calls was much more effective than patient engagement using letters or usual care. Practices that have access to a local DR screening program and have resources for such engagement strategies should consider using them as a means to improve their DR screening rates. TRIAL REGISTRATION ClinicalTrials.gov NCT03927859; https://clinicaltrials.gov/ct2/show/NCT03927859.
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Affiliation(s)
- Vess Stamenova
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Megan Nguyen
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Nike Onabajo
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Rebecca Merritt
- South Riverdale Community Health Centre, Toronto, ON, Canada
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, ON, Canada
| | - Kathryn Mossman
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Ivy Wong
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
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16
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Ricur G, Reyes J, Alfonso E, Marino RG. Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care. CURRENT OPHTHALMOLOGY REPORTS 2023; 11:1-12. [PMID: 36743397 PMCID: PMC9883823 DOI: 10.1007/s40135-023-00308-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- Giselle Ricur
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Joshua Reyes
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Eduardo Alfonso
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Raul Guillermo Marino
- Facultad de Ciencias Exactas Y Naturales, Universidad Nacional de Cuyo, Mendoza, Argentina
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17
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Mosenia A, Li P, Seefeldt R, Seitzman GD, Sun CQ, Kim TN. Longitudinal Use of Telehealth During the COVID-19 Pandemic and Utility of Asynchronous Testing for Subspecialty-Level Ophthalmic Care. JAMA Ophthalmol 2023; 141:56-61. [PMID: 36454548 PMCID: PMC9716434 DOI: 10.1001/jamaophthalmol.2022.4984] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Importance Telehealth in ophthalmology has traditionally focused on preventive disease screening with limited use in outpatient evaluation. The unique conditions of the COVID-19 pandemic afforded the opportunity to evaluate different implementations of teleophthalmology at scale, providing insight into expanding teleophthalmology care. Objective To compare telehealth use in ophthalmology with other specialties and assess the feasibility of augmenting ophthalmic telehealth encounters with asynchronous testing during the COVID-19 pandemic. Design, Setting, and Participants This quality improvement study evaluated retrospective, longitudinal, observational data from the first 18 months of the COVID-19 pandemic (January 1, 2020, through July 31, 2021) for 881 080 patients receiving care from outpatient primary care, cardiology, neurology, gastroenterology, surgery, neurosurgery, urology, orthopedic surgery, otolaryngology, obstetrics/gynecology, and ophthalmology clinics of the University of California, San Francisco. Asynchronous testing was evaluated for teleophthalmology encounters. Interventions A hybrid care model wherein ophthalmic testing data were acquired asynchronously and used to augment telehealth encounters. Main Outcomes and Measures Telehealth as a percentage of total volume of ambulatory care and use of asynchronous testing for ophthalmic conditions. Results The volume of in-person outpatient visits dropped by 83.3% (39 488 of 47 390) across the evaluated specialties at the onset of shelter-in-place orders for the COVID-19 pandemic, and the initial use of telehealth increased for these specialties before stabilizing over the 18-month study period. In ophthalmology, telehealth use peaked at 488 of 1575 encounters (31.0%) early in the pandemic and returned to mostly in-person visits as COVID-19 restrictions lifted. Elective use of telehealth was highest in gastroenterology, urology, neurology, and neurosurgery and lowest in ophthalmology. Asynchronous testing was combined with 126 teleophthalmology encounters, resulting in change of clinical management for 32 patients (25.4%) and no change for 91 (72.2%). Conclusions and Relevance Telehealth increased across various specialties during the COVID-19 pandemic. Combining teleophthalmic visits with asynchronous testing suggested that this approach is feasible for subspecialty-level evaluation. Additional study is needed to evaluate whether asynchronous testing outside the same institution could provide an effective and lasting approach for expanding the reach of ophthalmic telehealth.
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Affiliation(s)
- Arman Mosenia
- Department of Ophthalmology, University of California, San Francisco,School of Medicine, University of California, San Francisco,Department of Ophthalmology, Dell Medical School, The University of Texas at Austin
| | - Patrick Li
- Department of Medicine, NYU Langone Health, New York, New York
| | - Rick Seefeldt
- Department of Ophthalmology, University of California, San Francisco
| | - Gerami D. Seitzman
- Department of Ophthalmology, University of California, San Francisco,School of Medicine, University of California, San Francisco,Francis I. Proctor Foundation, University of California, San Francisco
| | - Catherine Q. Sun
- Department of Ophthalmology, University of California, San Francisco,School of Medicine, University of California, San Francisco,Francis I. Proctor Foundation, University of California, San Francisco
| | - Tyson N. Kim
- Department of Ophthalmology, University of California, San Francisco,School of Medicine, University of California, San Francisco
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18
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Massie J, Block SS, Morjaria P. The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review. Telemed J E Health 2022; 28:1753-1763. [PMID: 35612473 PMCID: PMC9805855 DOI: 10.1089/tmj.2021.0537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: Optometrists are increasingly adopting teleoptometry as an approach to delivering eye care. The coronavirus disease 2019 (COVID-19) pandemic has created further opportunities for optometrists to utilize innovation in telehealth to deliver eye care to individuals who experience access barriers. A systematic literature review is presented detailing the evidence to support the use of teleoptometry. Methods: Databases of MEDLINE, Global Health, and Web of Science were searched, and articles were included if they reported any involvement of optometrists in the delivery of telehealth. Findings were reported according to the mode of telehealth used to deliver eye care, telehealth collaboration type, and the format and geographical areas where eye care via telehealth is being delivered. Results: Twenty-seven relevant studies were identified. Only 11 studies included the role of optometrists as a member of the telehealth team where the scope of practice extended beyond creating and receiving referrals, collecting clinical data at in-person services, and continuing in-person care following consultation with an ophthalmologist. Both synchronous and asynchronous telehealth services were commonly utilized. Optometrists were most commonly involved in ophthalmology-led telehealth collaborations (n = 19). Eight studies reported optometrists independently delivering primary eye care via telehealth, and commonly included videoconferencing. Conclusion: The application of teleoptometry to deliver eye care is rapidly emerging, and appears to be a viable adjunct to the delivery of in-person optometry services. The review highlighted the scarcity of evidence surrounding the clinical benefits, safety, and outcomes of teleoptometry. Further research is required in this area.
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Affiliation(s)
- Jessica Massie
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Address correspondence to: Jessica Massie, BVisSci/MOptom, MScPHEC, International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | | | - Priya Morjaria
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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19
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Cohen MN, Ammar MJ, Mahmoudzadeh R, Salabati M, Gruver RS, Starr MR, Patel LG, Klufas MA, Garg SJ, Yonekawa Y, Kuriyan AE, Khan MA. Survey of Vitreoretinal Specialists in the United States Regarding Telemedicine During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1817-1822. [PMID: 35613374 DOI: 10.1089/tmj.2022.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: To evaluate the attitudes, beliefs, and practice patterns of vitreoretinal specialists regarding the utilization of telemedicine during the COVID-19 pandemic, and to identify features which may predict future telemedicine use. Methods: An 11-question anonymous survey was completed electronically in July 2020 by vitreoretinal specialists practicing in the United States. Results: The survey response rate was 13.0% (361/2,774). Thirty-five respondents (9.7%) had used telemedicine before March 1, 2020; after March 1, 2020, 170 (47.1%) reported using telemedicine (p < 0.001). Of the 170 respondents who reported telemedicine use, a majority (65.3%;111/170) performed 0-5 patient visits per week. Female retina specialists, younger physicians, and those with prior telemedicine usage were more likely to use telemedicine. Barriers to telemedicine use included concern for misdiagnosis (332/361, 92.0%), inability to obtain optical coherence tomography imaging (330/361, 91.4%), inability to obtain fundus imaging (327/361, 90.6%), lack of access to and/or comfort with the technology (261/361, 72.3%), potential legal liability (229/361, 63.4%), and low reimbursement (227/361, 62.9%). The majority of respondents (225/361; 62.3%) reported that telemedicine without ancillary imaging was not an acceptable way to evaluate patients. However, 59.2% (214/361) would find telemedicine acceptable if remote imaging was available. Conclusions: The pandemic led to a rapid adoption of telemedicine by vitreoretinal specialists. The majority of specialists using telemedicine performed five or fewer visits per week. The availability of remote imaging may increase confidence in clinical outcomes with a subsequent increase in utilization of telemedicine by vitreoretinal specialists.
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Affiliation(s)
- Michael N Cohen
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Michael J Ammar
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Raziyeh Mahmoudzadeh
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Mirataollah Salabati
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Rachel S Gruver
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Matthew R Starr
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Luv G Patel
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Michael A Klufas
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Sunir J Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Yoshihiro Yonekawa
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Ajay E Kuriyan
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - M Ali Khan
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
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20
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Virtual Access to Subspecialty Care. Prim Care 2022; 49:557-573. [PMCID: PMC9581700 DOI: 10.1016/j.pop.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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21
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Danesh H, Steel DH, Hogg J, Ashtari F, Innes W, Bacardit J, Hurlbert A, Read JCA, Kafieh R. Synthetic OCT Data Generation to Enhance the Performance of Diagnostic Models for Neurodegenerative Diseases. Transl Vis Sci Technol 2022; 11:10. [PMID: 36201202 PMCID: PMC9554224 DOI: 10.1167/tvst.11.10.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Optical coherence tomography (OCT) has recently emerged as a source for powerful biomarkers in neurodegenerative diseases such as multiple sclerosis (MS) and neuromyelitis optica (NMO). The application of machine learning techniques to the analysis of OCT data has enabled automatic extraction of information with potential to aid the timely diagnosis of neurodegenerative diseases. These algorithms require large amounts of labeled data, but few such OCT data sets are available now. Methods To address this challenge, here we propose a synthetic data generation method yielding a tailored augmentation of three-dimensional (3D) OCT data and preserving differences between control and disease data. A 3D active shape model is used to produce synthetic retinal layer boundaries, simulating data from healthy controls (HCs) as well as from patients with MS or NMO. Results To evaluate the generated data, retinal thickness maps are extracted and evaluated under a broad range of quality metrics. The results show that the proposed model can generate realistic-appearing synthetic maps. Quantitatively, the image histograms of the synthetic thickness maps agree with the real thickness maps, and the cross-correlations between synthetic and real maps are also high. Finally, we use the generated data as an augmentation technique to train stronger diagnostic models than those using only the real data. Conclusions This approach provides valuable data augmentation, which can help overcome key bottlenecks of limited data. Translational Relevance By addressing the challenge posed by limited data, the proposed method helps apply machine learning methods to diagnose neurodegenerative diseases from retinal imaging.
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Affiliation(s)
- Hajar Danesh
- School of Advanced Technologies in Medicine, Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, Tyne and Wear, UK.,Centre for Transformative Neuroscience and Institute of Biosciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Jeffry Hogg
- Royal Victoria Infirmary Eye Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle Upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Will Innes
- Royal Victoria Infirmary Eye Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle Upon Tyne, UK.,School of Computing, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Jaume Bacardit
- School of Computing, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Anya Hurlbert
- Centre for Transformative Neuroscience and Institute of Biosciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Jenny C A Read
- Centre for Transformative Neuroscience and Institute of Biosciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Rahele Kafieh
- School of Advanced Technologies in Medicine, Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran.,Centre for Transformative Neuroscience and Institute of Biosciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.,Department of Engineering, Durham University, South Road, Durham, UK
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22
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Blandford A, Abdi S, Aristidou A, Carmichael J, Cappellaro G, Hussain R, Balaskas K. Protocol for a qualitative study to explore acceptability, barriers and facilitators of the implementation of new teleophthalmology technologies between community optometry practices and hospital eye services. BMJ Open 2022; 12:e060810. [PMID: 35858730 PMCID: PMC9305899 DOI: 10.1136/bmjopen-2022-060810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Novel teleophthalmology technologies have the potential to reduce unnecessary and inaccurate referrals between community optometry practices and hospital eye services and as a result improve patients' access to appropriate and timely eye care. However, little is known about the acceptability and facilitators and barriers to the implementations of these technologies in real life. METHODS AND ANALYSIS A theoretically informed, qualitative study will explore patients' and healthcare professionals' perspectives on teleophthalmology and Artificial Intelligence Decision Support System models of care. A combination of situated observations in community optometry practices and hospital eye services, semistructured qualitative interviews with patients and healthcare professionals and self-audiorecordings of healthcare professionals will be conducted. Participants will be purposively selected from 4 to 5 hospital eye services and 6-8 affiliated community optometry practices. The aim will be to recruit 30-36 patients and 30 healthcare professionals from hospital eye services and community optometry practices. All interviews will be audiorecorded, with participants' permission, and transcribed verbatim. Data from interviews, observations and self-audiorecordings will be analysed thematically and will be informed by normalisation process theory and an inductive approach. ETHICS AND DISSEMINATION Ethical approval has been received from London-Bromley research ethics committee. Findings will be reported through academic journals and conferences in ophthalmology, health services research, management studies and human-computer interaction.
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Affiliation(s)
- Ann Blandford
- UCL Interaction Centre, University College London, London, UK
| | - Sarah Abdi
- UCL Interaction Centre, University College London, London, UK
| | | | - Josie Carmichael
- UCL Interaction Centre, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Giulia Cappellaro
- School of Management, University College London, London, UK
- Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - Rima Hussain
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
| | - Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
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23
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Considerations for Training and Workforce Development to Enhance Rural and Remote Ophthalmology Practise in Australia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148593. [PMID: 35886446 PMCID: PMC9315488 DOI: 10.3390/ijerph19148593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
Australia has one of the lowest per capita numbers of ophthalmologists among OECD countries, and they predominantly practise in metropolitan centres of the country. Increasing the size and distribution of the ophthalmology workforce is of critical importance. The objective of this review was to investigate the context of rural ophthalmology training and practise in Australia and how they relate to future ophthalmology workforce development. This scoping review was informed by Arksey and O’Malley’s framework and the methodology described by Coloqhuon et al. The search yielded 428 articles, of which 261 were screened for eligibility. Following the screening, a total of 75 articles were included in the study. Themes identified relating to rural ophthalmology training and practise included: Indigenous eye health; access and utilisation of ophthalmology-related services; service delivery models for ophthalmic care; ophthalmology workforce demographics; and ophthalmology workforce education and training for rural and remote practise. With an anticipated undersupply and maldistribution of ophthalmologists in the coming decade, efforts to improve training must focus on how to build a sizeable, fit-for-purpose workforce to address eye health needs across Australia. More research focusing on ophthalmology workforce distribution is needed to help identify evidence-based solutions for workforce maldistribution. Several strategies to better prepare the future ophthalmology workforce for rural practise were identified, including incorporating telehealth into ophthalmology training settings; collaborating with other health workers, especially optometrists and specialist nurses in eyecare delivery; and exposing trainees to more patients of Indigenous background.
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24
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Liddy C, Guglani S, Ratzlaff T, Campbell RJ, Cranston L, Miville A, Hove MT, Keely E. Expanding the scope of an eConsult service: acceptability and feasibility of an optometry–ophthalmology pilot project. CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 58:204-211. [PMID: 35131208 DOI: 10.1016/j.jcjo.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/29/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the feasibility and acceptability of connecting optometrists to ophthalmologists on an eConsult service. DESIGN Descriptive analysis of utilization data and an anonymous survey. PARTICIPANTS All eConsult cases sent by optometrists between March 2019 and February 2020 (utilization data); optometrists and ophthalmologists participating in the eConsult Vision Pilot Project (survey). METHODS Utilization data for the study period were collected automatically and underwent descriptive analysis. Participating optometrists and ophthalmologists received an email invitation to a survey assessing the project. RESULTS Thirteen optometrists from 5 clinics in the southeast region and 7 ophthalmologists were recruited to participate in the pilot project. Optometrists sent 109 eConsults in a 13-month period, representing 33% of all cases submitted to ophthalmology through the eConsult service provincially (March 2019-March 2020). Sixty-eight percent of respondents to an anonymous online survey valued the recruitment and engagement of eye care professionals from the same health region. The influence of the eConsult service was reported to have a "somewhat positive" (27%) to "very positive" (50%) influence on the relationship between the two professional groups. CONCLUSION The eConsult Vision Pilot Project fills a gap in service and provides an opportunity for patients to get access to specialty advice. We demonstrated that allowing optometrists to solicit specialist advice from ophthalmologists was acceptable and feasible.
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Affiliation(s)
- Clare Liddy
- C. T. Lamont Primary Healthcare Research Centre, Bruyère Research Institute, Ottawa, ON; Department of Family Medicine, University of Ottawa, Ottawa, ON; eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON.
| | - Sheena Guglani
- C. T. Lamont Primary Healthcare Research Centre, Bruyère Research Institute, Ottawa, ON; eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON
| | - Timothy Ratzlaff
- Department of Ophthalmology, Queens University and Kingston Health Sciences Centre, Kingston, ON
| | - Robert J Campbell
- Department of Ophthalmology, Queens University and Kingston Health Sciences Centre, Kingston, ON
| | - Lacey Cranston
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON
| | - Andrea Miville
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON
| | - Martin Ten Hove
- Department of Ophthalmology, Queens University and Kingston Health Sciences Centre, Kingston, ON
| | - Erin Keely
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON; Department of Medicine, University of Ottawa, Ottawa, ON; Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON
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25
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Elson MJ, Giangiacomo A, Maa AY, Branson SV, Maika E, Lin A, Gill K, Machuk RWA, Behn D, Kanjee R, Dotchin SA, Strungaru H, Lee T, Ramstead C, Gan K. Early Experience With Full-scope Shared-care Teleglaucoma in Canada. J Glaucoma 2022; 31:79-83. [PMID: 34172632 DOI: 10.1097/ijg.0000000000001905] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/04/2021] [Indexed: 12/29/2022]
Abstract
PRCIS Large Canadian full-scope, shared-care teleglaucoma facilitates efficient management and diversion of medically stable patients away from overburdened subspecialty clinics while allowing patients the convenience of shorter travel, shorter wait time, and continuity with one provider. This report shares Care1 protocol, early patient characteristics, and quality data. PURPOSE This paper describes early experience with Care1, a large full-scope, shared-care teleglaucoma program. Optometrists located in high-demand locations saw patients in-person, acquired clinical history, performed a physical examination, organized diagnostic testing, then uploaded data to a proprietary online platform where they were able to collaborate with participating ophthalmologists to make plans for patient care. MATERIALS AND METHODS The Care1 database was queried for all patients with a diagnosis of glaucoma or glaucoma suspect seen between February 2016 and March 2017. Clinical characteristics like diagnosis, ocular medication history, best-corrected visual acuity, intraocular pressure, cup-to-disc ratios, optical coherence tomography imaging results, and central corneal thickness were collected. Quality metrics studied included rates of referral to an in-person ophthalmologist and consistency of cup-to-disc assessments between in-person optometrists and remote ophthalmologists. RESULTS A total of 4070 patients received care at a Care1 teleophthalmology site in 2 provinces for glaucoma assessment from February 2016 to March 2017. The population was 55.1% female, and the average age was 57.8 years. Overall, 97.3% of patients had a best-corrected visual acuity between 20/20 and 20/40 and 3.3% had an intraocular pressure >26. An in-person consultation with an ophthalmologist was recommended for 1.9% of patients. CONCLUSION Early experience with this full-scope, shared-care teleglaucoma program in Canada indicates it is a convenient, collaborative model of care for glaucoma suspects, and medically stable glaucoma patients.
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Affiliation(s)
- Molly J Elson
- Department of Ophthalmology, Emory University School of Medicine
| | - Annette Giangiacomo
- VISN 7, Regional Telehealth Services, Atlanta Veterans Affairs Medical Center, Atlanta, GA
- Medical College of Wisconsin, Milwaukee, WI
| | - A Y Maa
- Department of Ophthalmology, Emory University School of Medicine
- VISN 7, Regional Telehealth Services, Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - Sara V Branson
- Department of Ophthalmology, Emory University School of Medicine
| | | | | | - Kulbir Gill
- Faculty of Medicine, University of British Columbia, Vancouver, BC
| | | | - Darren Behn
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton
| | - Raageen Kanjee
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | | | | | - Thomas Lee
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Kenman Gan
- Care1 Telemedicine
- Faculty of Medicine, University of British Columbia, Vancouver, BC
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton
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26
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Blais N, Tousignant B, Hanssens JM. Tele-refraction in tele-eye care settings. Clin Exp Optom 2022; 105:573-581. [PMID: 35094668 DOI: 10.1080/08164622.2021.2009736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Refraction is an important part of a comprehensive eye examination, and when performed remotely through information and communication technology or when its results are transmitted for remote analysis, this procedure is called tele-refraction. Uncorrected refractive errors are the main reason for consultation in primary eye care, and an increasing number of eye care providers offer tele-refraction services in response to the global demand. Even so, very little literature exists on how the correction of refractive errors can be managed through tele-eye care. The objectives of this review are to examine the integration of tele-refraction in different eye care models and to report the existing findings regarding patient satisfaction towards tele-refraction and the efficacy of tele-refraction. Searches were undertaken on Medline, Embase, EBM Reviews, CINAHL and Web of Science to identify relevant articles. All original studies describing a clinical tele-refraction service and its outcomes were included. Out of 1322 articles, 15 were retained for analysis and have shown that tele-refraction has been provided for general eye care (n = 10; 67%), refractive-only examinations (n = 3; 20%) or disease-specific screening (n = 2; 13%). Ten (67%) had a hybrid telemedicine modality. Given the small number of included studies and the lack of outcomes comparing refractive errors between face-to-face and remote refraction, it is concluded that the current scientific literature does not reflect the increasing availability of tele-refraction in clinical practice. More studies on remote refraction should be conducted to better understand its efficacy, cost-effectiveness and impacts on patient satisfaction and management.
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Affiliation(s)
- Nicolas Blais
- School of Optometry, Universite de Montreal, Montreal, Canada
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Stewart C, Coffey-Sandoval J, Souverein EA, Lee TC, Nallasamy S. Provider-to-provider synchronous telemedical consultations in ophthalmology: Advice for implementation. Digit Health 2022; 8:20552076221117744. [PMID: 35935712 PMCID: PMC9350499 DOI: 10.1177/20552076221117744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
We previously demonstrated the non-inferiority of a synchronous (real-time) telemedicine model (compared to gold standard in-person examination) for pediatric ophthalmology consultations using a Polycom conferencing system, smart glasses, digital slit lamp, and digital indirect ophthalmoscope. Although we acknowledge there is a learning curve associated with becoming proficient with this system, we believe implementation of a synchronous telemedicine model is advantageous to both patient and provider in the right care setting. In conducting 348 such examinations over the course of our study and dozens of subsequent examinations after the implementation of our model in the community, we have gleaned many insights into optimizing the experience and efficiency. We wish to share these insights to help guide those interested in adopting such a model to expand access to specialists for underserved patients or improve efficiencies in their practice.
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Affiliation(s)
- Carly Stewart
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Erik A. Souverein
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Thomas C. Lee
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Sudha Nallasamy
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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28
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Ali AM, O’Connell NM, Tatham AJ. Patient satisfaction with virtual compared to face-to-face glaucoma clinics. Acta Ophthalmol 2021; 99:e1540-e1542. [PMID: 33960135 DOI: 10.1111/aos.14836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/06/2021] [Accepted: 02/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Ameer M. Ali
- Princess Alexandra Eye Pavilion, and Department of Ophthalmology University of Edinburgh Edinburgh UK
| | - Niamh M. O’Connell
- Princess Alexandra Eye Pavilion, and Department of Ophthalmology University of Edinburgh Edinburgh UK
| | - Andrew J. Tatham
- Princess Alexandra Eye Pavilion, and Department of Ophthalmology University of Edinburgh Edinburgh UK
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29
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Chen JS, Coyner AS, Chan RP, Hartnett ME, Moshfeghi DM, Owen LA, Kalpathy-Cramer J, Chiang MF, Campbell JP. Deepfakes in Ophthalmology. OPHTHALMOLOGY SCIENCE 2021; 1:100079. [PMID: 36246951 PMCID: PMC9562356 DOI: 10.1016/j.xops.2021.100079] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/01/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
Purpose Generative adversarial networks (GANs) are deep learning (DL) models that can create and modify realistic-appearing synthetic images, or deepfakes, from real images. The purpose of our study was to evaluate the ability of experts to discern synthesized retinal fundus images from real fundus images and to review the current uses and limitations of GANs in ophthalmology. Design Development and expert evaluation of a GAN and an informal review of the literature. Participants A total of 4282 image pairs of fundus images and retinal vessel maps acquired from a multicenter ROP screening program. Methods Pix2Pix HD, a high-resolution GAN, was first trained and validated on fundus and vessel map image pairs and subsequently used to generate 880 images from a held-out test set. Fifty synthetic images from this test set and 50 different real images were presented to 4 expert ROP ophthalmologists using a custom online system for evaluation of whether the images were real or synthetic. Literature was reviewed on PubMed and Google Scholars using combinations of the terms ophthalmology, GANs, generative adversarial networks, ophthalmology, images, deepfakes, and synthetic. Ancestor search was performed to broaden results. Main Outcome Measures Expert ability to discern real versus synthetic images was evaluated using percent accuracy. Statistical significance was evaluated using a Fisher exact test, with P values ≤ 0.05 thresholded for significance. Results The expert majority correctly identified 59% of images as being real or synthetic (P = 0.1). Experts 1 to 4 correctly identified 54%, 58%, 49%, and 61% of images (P = 0.505, 0.158, 1.000, and 0.043, respectively). These results suggest that the majority of experts could not discern between real and synthetic images. Additionally, we identified 20 implementations of GANs in the ophthalmology literature, with applications in a variety of imaging modalities and ophthalmic diseases. Conclusions Generative adversarial networks can create synthetic fundus images that are indiscernible from real fundus images by expert ROP ophthalmologists. Synthetic images may improve dataset augmentation for DL, may be used in trainee education, and may have implications for patient privacy.
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Affiliation(s)
- Jimmy S. Chen
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Aaron S. Coyner
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - M. Elizabeth Hartnett
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Darius M. Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Leah A. Owen
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jayashree Kalpathy-Cramer
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts
- Massachusetts General Hospital & Brigham and Women’s Hospital Center for Clinical Data Science, Boston, Massachusetts
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - J. Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
- Correspondence: J. Peter Campbell, MD, MPH, Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR 97239.
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30
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Rodriguez T, Delepine Q, Fantou P, Costes M, Somme D, Mouriaux F, Soethoudt M. [Validation of an ophtalmology tele-expertise protocol in nursing homes]. J Fr Ophtalmol 2021; 44:1516-1522. [PMID: 34774347 DOI: 10.1016/j.jfo.2021.05.015] [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: 04/26/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Assisted living residents are a fragile population with limited access to health care. In recent years, telemedicine has developed in several specialties, including ophthalmology. The main objective of our study is the validation of an ophthalmology telemedicine protocol in assisted living facilities. MATERIALS AND METHODS This is a retrospective, multicentric, descriptive study including 4 assisted living facilities in the Rennes area. An ophthalmic technician examined residents for one half-day per week. The examination was performed directly in the patient's room, in bed or in a chair, with portable equipment. An ophthalmologist from our service interpreted the results remotely on a deferred basis within 7 days. Appropriate medical or surgical care was then offered to the patient depending on the diagnosis. RESULTS We included 113 residents. A complete, interpretable examination was achieved in 84.1% of cases. One or more ophthalmic conditions were diagnosed in 57.5% of the residents. Of the residents who were then seen at the university medical center, 65% underwent a scheduled surgical procedure or laser. Visual acuity was significantly improved subsequent to the telemedicine encounter. DISCUSSION The success rate of a complete, interpretable examination allows us to now validate our nursing home examination procedure. In addition to bringing a large amount of initially unknown information to the medical and paramedical staff of the structure, ophthalmology telemedicine allows for a significant improvement in visual acuity. CONCLUSION This project validated the feasibility of ophthalmology telemedicine in an assisted living setting. This protocol may also be applicable to other health care settings (penitentiaries, mental health institutions, etc.).
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Affiliation(s)
- T Rodriguez
- Service d'ophtalmologie, CHRU Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Q Delepine
- Service d'ophtalmologie, CHRU Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - P Fantou
- Service d'ophtalmologie, CHRU Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - M Costes
- Service d'ophtalmologie, CHRU Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - D Somme
- Service d'ophtalmologie, CHRU Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - F Mouriaux
- Service d'ophtalmologie, CHRU Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - M Soethoudt
- Service d'ophtalmologie, CHRU Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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31
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Hanrahan G, Ennis C, Conway M, Murtagh P, Brosnahan D. An evaluation of the safety and effectiveness of telephone triage in prioritising patient visits to an ophthalmic emergency department - the impact of COVID-19. Ir J Med Sci 2021; 191:2393-2398. [PMID: 34668106 PMCID: PMC8526050 DOI: 10.1007/s11845-021-02806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022]
Abstract
Background During the COVID-19 crisis, a new nurse and doctor-led telephone triage model of care was evaluated as a method of prioritising essential visits to the ophthalmic accident and emergency department in the Royal Victoria Eye and Ear Hospital. This new method of service is known as “Telehealth” or “E-Health”. Aims To assess the safety and efficacy of a Telehealth model of care ultilised during the COVID-19 pandemic. Methods A prospective study was undertaken in the Royal Victoria Eye and Ear Hospital where the telephone triage records were examined over a 28-day period during the COVID-19 pandemic from 19 March 2020 to 16 April 2020 inclusive. Results During this period, 1120 telephone calls were received by the call centre. A total of 739 patients attended the emergency department over the 28-day period compared to 2247 during the same period in 2019. Conclusion To reduce risk of transmission, the COVID-19 pandemic has necessitated novel ways of interacting with patients and sharing healthcare information. Our new mode of service provision in the RVEEH portrays the effectiveness of Telehealth. This study gives us further scope to improve this model of care into the future.
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Chen DA, Tran AQ, Dinkin MJ, Lelli GJ. Ophthalmic Virtual Visit Utilization and Patient Satisfaction During the COVID-19 Pandemic. Telemed J E Health 2021; 28:798-805. [PMID: 34609934 DOI: 10.1089/tmj.2021.0392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Due to the COVID-19 pandemic, there was a surge in synchronous ophthalmic telehealth visits. The purpose of this study is to analyze the utilization and patient satisfaction of synchronous ophthalmic video visits over the course of the COVID-19 pandemic. Methods: In this retrospective, single-center cross-sectional study, 1,756 patients seen through synchronous video visits between March 1, 2020, and March 31, 2021, were identified using billing codes. E-mails containing a validated, 11-item, telehealth satisfaction scale were sent to patients who had at least one video visit within the study period. Questions were scored on a 1-4 scale, corresponding to poor, fair, good, and excellent. Main outcome measures included patient satisfaction scores, frequency of repeat video visits, and primary visit diagnoses. Results: The top 3 subspecialties by virtual visit volume were oculoplastic surgery (999 visits, 42.9%), neuro-ophthalmology (331 visits, 17.0%), and cornea (254 visits, 14.2%). The top 3 diagnoses seen were chalazion/hordeolum, dry eye, and meibomian gland dysfunction. The overall survey response rate was 14.3% (252 participants). The mean patient satisfaction score was 3.67 ± 0.63, with no significant difference in scores between specialties. A total of 380 (21%) patients had repeat virtual visits. Mean survey response scores were significantly higher for patients with repeat visits than those without (3.82 ± 0.42 vs. 3.62 ± 0.68, p = 0.03). Patients undergoing oculoplastic services were more likely to have repeat visits (odds ratio 2.58, 95% confidence interval 2.18-3.06, p < 0.001). Multivariate regression analysis found that provider thoroughness/skillfulness was the most predictive feature of the patient returning to a telehealth encounter (p = 0.01). Conclusions: Our study suggests that synchronous videoconferencing for ophthalmology is a highly satisfactory delivery method and will likely find continued success in select subspecialties as the pandemic fades.
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Affiliation(s)
- Darren A Chen
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA
| | - Ann Q Tran
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA
| | - Marc J Dinkin
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Gary J Lelli
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA
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Almagati R, Kran BS. Implications of a Remote Study of Children With Cerebral Visual Impairment for Conducting Virtual Pediatric Eye Care Research: Virtual Assessment Is Possible for Children With CVI. Front Hum Neurosci 2021; 15:733179. [PMID: 34594196 PMCID: PMC8477018 DOI: 10.3389/fnhum.2021.733179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
The Pandemic of 2020 impacted conducting in-person research. Our proposed project already had an asynchronous online component but was later morphed to add a synchronous online component, thereby eliminating the need for in-person assessment. The project compares the results of various tests between a group of children with Cerebral Visual Impairments (CVI) (N = 4) and an age-matched sample of children without CVI (N = 3) from a pediatric low vision clinic. This model was trialed with a small convenient sample of typically developing children in the same age range (N = 4). Given the positive feedback, recruitment for the larger study was done via encrypted e-mail rather than through traditional mailing. The asynchronous components included recruitment, pre-assessment information, the Flemish CVI questionnaire, Vineland-3 comprehensive parent questionnaire for assessment of age equivalent, and vision function tests, such as contrast sensitivity. The synchronous components were administered via Zoom telehealth provided by necoeyecare.org and included assessment of visual acuity via the Freiburg Visual Acuity and Contrast Test (FrACT) electronic software and assessment of visual perceptual batteries via the Children’s Visual Impairment Test for developmental ages 3–6-years (CVIT 3–6). Our virtual testing protocol was successful in the seven participants tested. This paper reviews and critiques the model that we utilized and discusses ways in which this model can be improved. Aside from public health considerations during the pandemic, this approach is more convenient for many families. In a broader perspective, this approach can be scaled for larger N studies of rare conditions, such as CVI without being confined by proximity to the researcher.
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Affiliation(s)
- Reem Almagati
- New England College of Optometry (NECO), Boston, MA, United States
| | - Barry S Kran
- New England College of Optometry (NECO), Boston, MA, United States.,NECO Center for Eye Care at Perkins, Watertown, MA, United States
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Vongsachang H, Lagstein O, Boland MV, Repka MX, Kraus CL, Collins ME. Telemedicine utilization by pediatric ophthalmologists during the COVID-19 pandemic. J AAPOS 2021; 25:293-295.e1. [PMID: 34600105 PMCID: PMC8479503 DOI: 10.1016/j.jaapos.2021.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/02/2022]
Abstract
Understanding provider perspectives on telemedicine adoption during the COVID-19 pandemic can help inform best practices for delivering pediatric ophthalmic care safely and remotely. In this online survey distributed to two national pediatric ophthalmology list-servs, respondents in July-August 2020 (n = 104) compared with respondents in March-April 2020 (n = 171) were more likely to report not using and not planning on using telemedicine. The July-August respondents who did not use telemedicine were concerned about the limitations in care provided, challenges with implementation, and perceived negative effects on the doctor-patient relationship. These findings demonstrate a lack of sustained uptake of telemedicine in the first 6 months of the pandemic and concerns that should be addressed to facilitate integration of this approach in pediatric ophthalmic care.
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Affiliation(s)
- Hursuong Vongsachang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oded Lagstein
- Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel
| | - Michael V Boland
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney L Kraus
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Gonçalves C, da Mata A, Lapão LV. Leveraging technology to reach global health: The case of telemedicine in São Tomé and Príncipe health system. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Purpose of Review The field of teleglaucoma has expanded rapidly in recent years with several large-scale teleglaucoma screening programs in existence throughout the world. Additionally, teleglaucoma programs for use in disease management are under study. The limited access to care that resulted from the COVID-19 pandemic highlighted the need for expansion of such programs. This article reviews the literature on teleglaucoma for screening and management of glaucoma, discussing considerations for incorporating teleglaucoma into clinical practice. Recent Findings Teleglaucoma screening reduces the rate of false-positive referrals and can accurately screen at-risk populations with accuracy similar to in-person screening. The use of teleglaucoma for the management of glaucoma shows promise for low-risk patients with early disease. Furthermore, teleglaucoma is cost-effective and reduces travel burden for patients resulting in high patient satisfaction. Summary Teleglaucoma offers potential for improving access to glaucoma care, reducing the burden on patients and health care systems.
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Nuzzi R, Bovone D, Maradei F, Caselgrandi P, Rossi A. Teleophthalmology Service: Organization, Management, Actual Current Applications, and Future Prospects. Int J Telemed Appl 2021; 2021:8876957. [PMID: 34188678 PMCID: PMC8192214 DOI: 10.1155/2021/8876957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/18/2021] [Accepted: 05/25/2021] [Indexed: 12/03/2022] Open
Abstract
Teleophthalmology (TO) consists of the clinical and therapeutic approach to the patient (e-Health) using informatic and telecommunication systems. Already widespread worldwide, it aims to improve patient care, expand the healthcare offer, and access to medical care by reducing overall costs. Despite the organizational, legal, and management difficulties, the substantial economic investments necessary for the start-up of equipped structures and efficient territorial services are amply rewarded by economic results and optimal services for professionals and patients. This review specifically analyses the current scenario of teleophthalmology, the points for and against its application in different sociodemographic realities, and in particular, the current and future fields of use.
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Affiliation(s)
- Raffaele Nuzzi
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Davide Bovone
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Fabio Maradei
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Caselgrandi
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
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Ghazala FR, Hamilton R, Giardini ME, Ferguson A, Poyser OB, Livingstone IA. Live teleophthalmology avoids escalation of referrals to secondary care during COVID-19 lockdown. Clin Exp Optom 2021; 104:711-716. [PMID: 34016025 DOI: 10.1080/08164622.2021.1916383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CLINICAL RELEVANCE Following the COVID-19 lockdown, uptake of slitlamp-enabled live teleophthalmology increased. Its use contributed to a reduction of referrals escalated to secondary care during-lockdown (avoided: 64% pre-lockdown vs 86% during-lockdown). BACKGROUND Live teleophthalmology using video conferencing allows real-time, three-way consultation between secondary care, community providers and patients, improving interpretation of slit lamp findings and potentially reducing referrals to secondary care. NHS Forth Valley implemented live teleophthalmology in March 2019. In March 2020, the COVID-19 pandemic created urgency to deliver ophthalmic care while minimising the risk of contracting or spreading the disease. We aim to compare the uptake and two outcomes (number of avoided secondary care referrals; pattern of presenting conditions) of live teleophthalmology consultations in NHS Forth Valley before and during the COVID-19 national lockdown. METHODS An NHS secure video conferencing platform connected the video slit lamps of optometrists, or an iPad mounted on a slit lamp and viewing through the eyepieces, to a secondary care ophthalmologist via a virtual live clinic/waiting area. Data about avoiding a secondary care referral were extracted from a post-consultation ophthalmologist survey for 14 months of data. Pre- and during-lockdown intervals were before/after 23 March 2020, when routine eyecare appointments were suspended. Numbers of avoided referrals to secondary care and patterns of presenting conditions were compared for pre- and during-lockdown periods. RESULTS The COVID-19 pandemic markedly increased use of live teleophthalmology in NHS Forth Valley. Surveys were completed for 164 of 250 (66%) teleophthalmology consultations over the study period. Data from 154 surveys were analysed, 78 and 76 for the pre- and during-lockdown periods, respectively. Significantly more during-lockdown (86%) than pre-lockdown (64%; difference 21%, 95% CI 8-34%, p = 0.001) surveys indicated that referrals to secondary care were avoided. CONCLUSION Survey data from ophthalmologists suggest significantly fewer escalations to secondary care due to teleophthalmology use.
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Affiliation(s)
- Fadi R Ghazala
- Tennent Institute of Ophthalmology, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Ruth Hamilton
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Mario E Giardini
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Li JPO, Thomas AA, Kilduff CL, Logeswaran A, Ramessur R, Jaselsky A, Sim DA, Hay GR, Thomas PB. Safety of video-based telemedicine compared to in-person triage in emergency ophthalmology during COVID-19. EClinicalMedicine 2021; 34:100818. [PMID: 33842860 PMCID: PMC8021278 DOI: 10.1016/j.eclinm.2021.100818] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND the need for social distancing midst the COVID-19 pandemic has forced ophthalmologists to innovate with telemedicine. The novel process of triaging emergency ophthalmology patients via videoconsultations should reduce hospital attendances. However, the safety profile of such services were unknown. METHODS in this retrospective cohort study, we reviewed case notes of 404 adults who used our videoconsultation service from 20/04/2020 to 03/05/2020. We compared these to 451 patient who attended eye casualty in person at the same time who were deemed not to require same day ophthalmic examination. FINDINGS patients seen by videoconsultations tended to be younger (Median = 43 years, Inter-quartile range = 27 vs Median= 49 years, Inter-quartile range = 28)'. More males used the face-to-face triage (55%) while more females used videoconsultation (54%)%. Fewer patients seen by videoconsultations required specialist review compared to face-face triage [X 2 (1, N = 854) = 128.02, p<0.001)]. 35.5% of the patients initially seen by videoconsultation had unplanned reattendance within 1 month, compared to 15.7% in the group initially seen in person. X 2 (1, N = 234) = 7.31, p = 0.007). The rate of actual harm was no different (at 0% for each method), with perfect inter-grader correlation when graded independently by two senior ophthalmologists. 97% of patients seen on the video platform surveyed were satisfied with their care. INTERPRETATION we demonstrate comparable patient safety of videoconsultations at one-month follow-up to in person review. The service is acceptable to patients and reduces the risk of COVID-19 transmission. We propose that videoconsultations are effective and desirable as a tool for triage in ophthalmology. FUNDING the research supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology who fund PT and DS's time to conduct research. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
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Affiliation(s)
- Ji-Peng Olivia Li
- Emergency Ophthalmology Clinical Research and Innovation Unit, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
| | - Alice A.P. Thomas
- Emergency Ophthalmology Clinical Research and Innovation Unit, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
| | - Caroline L.S. Kilduff
- Emergency Ophthalmology Clinical Research and Innovation Unit, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
| | - Abison Logeswaran
- Emergency Ophthalmology Clinical Research and Innovation Unit, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
| | - Rishi Ramessur
- Emergency Ophthalmology Clinical Research and Innovation Unit, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
| | - Anton Jaselsky
- Emergency Ophthalmology Clinical Research and Innovation Unit, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
| | - Dawn A. Sim
- Department of Digital Medicine, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Gordon R. Hay
- Emergency Ophthalmology Clinical Research and Innovation Unit, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
- UCL Institute of Ophthalmology, London, United Kingdom
- Corresponding author at: NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD, United Kingdom.
| | - Peter B.M. Thomas
- Department of Digital Medicine, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Corresponding author.
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Staffieri SE, Mathew AA, Sheth SJ, Ruddle JB, Elder JE. Parent satisfaction and acceptability of telehealth consultations in pediatric ophthalmology: initial experience during the COVID-19 pandemic. J AAPOS 2021; 25:104-107. [PMID: 33689911 DOI: 10.1016/j.jaapos.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
Telehealth in pediatric ophthalmology has predominantly been utilized and reported in the setting of clinician-to-clinician opinion or store-and-forward of images, particularly in the diagnosis and management of retinopathy of prematurity (ROP). We present our initial experience of using a telehealth model of care to deliver real-time specialist pediatric ophthalmology services during the COVID-19 pandemic. Over a 5-week period, parents were invited to complete an anonymous survey following a telehealth ophthalmology consultation for their child. The survey explored their satisfaction, acceptance, and feedback relating to their experience. With an overall response rate of 49.4%, satisfaction was high (43.8% very satisfied; 38.2% satisfied). Most parents (71.9%) would consider telehealth for future ophthalmology consultations for their child.
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Affiliation(s)
- Sandra E Staffieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria; Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria.
| | - Anu A Mathew
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria; Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria
| | - Shivanand J Sheth
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria
| | - Jonathan B Ruddle
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria
| | - James E Elder
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria; Department of Paediatrics, University of Melbourne, Parkville, Victoria
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Gheorghe CM, Purcărea VL, Gheorghe IR. Trick or treat: Social Media's dissemination power of ophthalmologic information in the pandemic context. Rom J Ophthalmol 2021; 65:125-129. [PMID: 34179576 PMCID: PMC8207867 DOI: 10.22336/rjo.2021.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Social Media in the COVID-19 pandemic context has become a real dissemination medium of ophthalmology information for both physicians and health care consumers. This trend of sharing information has revealed new and innovative interventions in Ophthalmology such as teleophthalmology on Social Media by providing synchronous and asynchronous consultations, education, and prevention solutions as well as scientific research findings. This paper is a review of the current challenges and limitations faced by ophthalmologists and health care consumers during the COVID-19 pandemic.
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Affiliation(s)
- Consuela-Mădălina Gheorghe
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Victor Lorin Purcărea
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Iuliana-Raluca Gheorghe
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Ravulaparthi G, Chelluri S. Utility of mobile application-based teleophthalmology services across India during the COVID-19 pandemic. Indian J Ophthalmol 2021; 69:996-997. [PMID: 33727478 PMCID: PMC8012949 DOI: 10.4103/ijo.ijo_3612_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gayatri Ravulaparthi
- Department of Ophthalmology, Mamata Academy of Medical Sciences, Bachupally, Telangana, India
| | - Subrahmanyam Chelluri
- Consultant Cardiac Anaesthesiologist, Sunshine Hospital, Secunderabad, Telangana, India
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Stewart C, Coffey-Sandoval J, Reid MW, Ho TC, Lee TC, Nallasamy S. Reliability of telemedicine for real-time paediatric ophthalmology consultations. Br J Ophthalmol 2021; 106:1157-1163. [PMID: 33722800 PMCID: PMC9340009 DOI: 10.1136/bjophthalmol-2020-318385] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/30/2021] [Accepted: 02/27/2021] [Indexed: 11/23/2022]
Abstract
Background/aims To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions. Methods Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0–17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was <1.5% for management plan or <15% for diagnosis discrepancies. Results 210 patients participated in 348 examinations. 131 (62.4%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98–1.00) and disease categorisation (kappa=0.94–1.00) (p<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5%) and would participate in another in the future (97.1%). Conclusion Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology.
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Affiliation(s)
- Carly Stewart
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Mark W Reid
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Tiffany C Ho
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Thomas C Lee
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sudha Nallasamy
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA .,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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González-Márquez F, Luque-Romero L, Ruiz-Romero MV, Castillón-Torre L, Hernández-Martínez FJ, Olea-Pabón L, Moro-Muñoz S, García-Díaz RDM, García-Garmendia JL. Remote ophthalmology with a smartphone adapter handled by nurses for the diagnosis of eye posterior pole pathologies during the COVID-19 pandemic. J Telemed Telecare 2021:1357633X21994017. [PMID: 33599527 DOI: 10.1177/1357633x21994017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The use of smartphones to provide specialist ophthalmology services is becoming a more commonly used method to support patients with eye pathologies. During the COVID-19 pandemic, demand for telehealth services such as tele-ophthalmology, is increasing rapidly.Methods: In 2019, the agreement between diagnostic tests was investigated by comparing the diagnostic performance for eye posterior pole pathologies of the images obtained by a smartphone coupled to a medical device known as open retinoscope (OR), handled by a nurse and subsequently assessed by an ophthalmologist versus the images obtained by an ophthalmologist using a slit lamp associated to a 76 diopter indirect ophthalmic lens (Volk Super FieldVR ) (SL-IOL) at the outpatient department of a hospital. The OR used in this study worked with a 28 diopter indirect lens.Results: An examination of 151 dilated eyes (79 adult patients, mean age of 66.7 years, 59.5% women) was conducted. Sensitivity was 98.9%, specificity was 89.8%, the positive predictive value was 93.8% and the negative predictive value was 98.2%. The kappa index between both tests was 0.90 (95% CI: 0.83-0.97) in basic diagnosis, 0.81 (95% CI: 0.74-0.89) in syndromic diagnosis (13 categories) and 0.70 (95% CI: 0.62-0.77) in advanced diagnosis (23 categories).Discussion: Images obtained by a nurse using a smartphone coupled to the OR and subsequently assessed by an ophthalmologist showed a high diagnostic performance for eye posterior pole pathologies, which could pave the way for remote ophthalmology systems for this patient group.
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Affiliation(s)
- Florencio González-Márquez
- Department of Critical Care and Emergency, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | - Luis Luque-Romero
- Department of Investigation Primary Healthcare District Aljarafe-Sevilla Norte, Mairena del Aljarafe, Seville, Spain
| | - María Victoria Ruiz-Romero
- Department of Quality and Investigation, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | - Luis Castillón-Torre
- Department of Ophthalmology, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | | | - Luna Olea-Pabón
- Department of Critical Care and Emergency, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | - Serafín Moro-Muñoz
- Department of Information Systems, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | | | - José Luis García-Garmendia
- Department of Critical Care and Emergency, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
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Perdoncini NN, Schussel JL, Amenábar JM, Torres-Pereira CC. Use of smartphone video calls in the diagnosis of oral lesions: Teleconsultations between a specialist and patients assisted by a general dentist. J Am Dent Assoc 2021; 152:127-135. [PMID: 33494867 DOI: 10.1016/j.adaj.2020.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Teleassistance in dentistry enables the support of dentists in areas without access to specialists. The aim of this study was to assess the feasibility and accuracy of synchronous teleconsultation in oral medicine. METHODS Patients referred for specialized care owing to oral lesions were evaluated in person by a general dentist who obtained photographs of the lesions with a smartphone. The images were sent via a mobile application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for case management. Then a second specialist, blinded to the first evaluation, assessed the oral lesion in person and defined a diagnosis, which was considered as the reference standard. Diagnoses from the remote and the face-to-face consultations were compared in percentage levels of agreement and κ coefficient. RESULTS Thirty-three patients, 25 through 83 years old, had 41 oral lesions. The average teleconsultation length was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the reference standard (κ = 0.922). CONCLUSIONS Synchronous teleconsultation can provide reliable remote diagnosis through the support to primary care health care professionals in management of oral lesions. PRACTICAL IMPLICATIONS Earlier diagnosis of malignancies, improvement of access for unassisted populations, and reduction of unnecessary referrals are possible practical implications of remote support of a specialist in the management and diagnosis of oral lesions.
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Capitena Young CE, Patnaik JL, Seibold LK, Kahook MY. Attitudes and Perceptions Toward Virtual Health in Eye Care During Coronavirus Disease 2019. Telemed J E Health 2021; 27:1268-1274. [PMID: 33524299 DOI: 10.1089/tmj.2020.0424] [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: 10/22/2022] Open
Abstract
Purpose: To evaluate attitudes and perceptions toward virtual health (VH) and its usage among eye care providers before, during, and after the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: In April and May 2020, an online survey comprised of questions regarding past and current VH practices, as well as plans for future use was distributed among eye care providers nationwide. Results: Of the 117 eye care providers who completed the survey, 96.6% were not using VH before the COVID-19 pandemic. In contrast, 77.4% reported using VH during the pandemic. The majority of visits were for red eye (64.4%, n = 56) and ocular surface complaints (58.6%, n = 51). Examination components tested virtually varied, but most respondents felt these were at least "somewhat reliable." Almost half of respondents (45%) felt it was "very easy" or "somewhat easy" to implement VH and the majority (53.8%, n = 43) were able to get it up and running in under a week. The majority felt the transition to VH was positive (57.5%), however, only 50.4% (n = 53) of those providers planned to use VH regularly once able to see patients safely in clinic again. Conclusions: While the majority of U.S. eye care providers who responded were not using VH before the COVID-19 pandemic, just months into the U.S. outbreak, 77.4% were using VH in their daily practice. In general, providers used these platforms for urgent examinations, adnexal disease, and postoperative care most often. The majority felt the transition was a positive one, however, only half planned to continue regular use of VH once the pandemic ended.
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Affiliation(s)
- Cara E Capitena Young
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Leonard K Seibold
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Malik Y Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Misra N, Khanna RC, Mettla AL, Marmamula S, Rathi VM, Das AV. Role of teleophthalmology to manage anterior segment conditions in vision centres of south India: EyeSmart study-I. Indian J Ophthalmol 2020; 68:362-367. [PMID: 31957728 PMCID: PMC7003575 DOI: 10.4103/ijo.ijo_991_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: To study the role of teleophthalmology (TO) in the diagnosis and treatment of anterior segment conditions (including adnexal conditions) in rural areas. Methods: This is a pilot study of 5,604 patients, who visited primary vision centres (VCs) for 1 week from 1-7 September 2018. The patients were examined by a vision technician (VT) to identify those who may need teleconsultation. The centres were located in 16 districts of four Indian states of Andhra Pradesh, Telangana, Odisha, and Karnataka. The demographic profile, along with the role of teleconsultation was reviewed. Results: Teleconsultation was advised in 6.9% of the patients, out of which 59.6% were referred to a higher level of care, and 40.4% were treated directly at the VC. Teleconsultations were higher among males (7.0% as compared to 6.6% in females), though not statistically significant (P = 0.55). Teleconsultation was higher in the older population, that is, 60 years and above (14.5%); those with severe visual impairment (VI) (21%) and blindness (31.1%); and in the states of Telangana (11%) and Andhra Pradesh (6.3%). It was noted that 45% of the patients who underwent teleconsultation had pathologies related to ocular surface, cornea and lid, and adnexa-related conditions. Conclusion: Teleconsultation has a significant role in the management of anterior segment conditions in bridging the gap between the patients and ophthalmologists in rural India. TO can also play an important role in the diagnosis and management of anterior segment, lid, and adnexa-related pathologies.
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Affiliation(s)
- Neha Misra
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Asha L Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute; Brien Holden Institute of Optometry and Vision Science; Wellcome Trust/ Department of Biotechnology India Alliance Research Fellow, Hyderabad, Telangana, India
| | - Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India
| | - Anthony V Das
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Cicinelli MV, Marmamula S, Khanna RC. Comprehensive eye care - Issues, challenges, and way forward. Indian J Ophthalmol 2020; 68:316-323. [PMID: 31957719 PMCID: PMC7003576 DOI: 10.4103/ijo.ijo_17_19] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
As we move from a disease-specific care model toward comprehensive eye care (CEC), there is a need for a more holistic and integrated approach involving the health system. It should encompass not only treatment, but also prevention, promotion, and rehabilitation of incurable blindness. Although a few models already exist, the majority of health systems still face the challenges in the implementation of CEC, mainly due to political, economic, and logistic barriers. Shortage of eye care human resources, lack of educational skills, paucity of funds, limited access to instrumentation and treatment modalities, poor outreach, lack of transportation, and fear of surgery represent the major barriers to its large-scale diffusion. In most low- and middle-income countries, primary eye care services are defective and are inadequately integrated into primary health care and national health systems. Social, economic, and demographic factors such as age, gender, place of residence, personal incomes, ethnicity, political status, and health status also reduce the potential of success of any intervention. This article highlights these issues and demonstrates the way forward to address them by strengthening the health system as well as leveraging technological innovations to facilitate further care.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Srinivas Marmamula
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Senior Visiting Fellow - School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Wellcome Trust / Department of Bio-technology India Alliance fellow, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Senior Visiting Fellow - School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Lin TC, Chiang YH, Hsu CL, Liao LS, Chen YY, Chen SJ. Image quality and diagnostic accuracy of a handheld nonmydriatic fundus camera: Feasibility of a telemedical approach in screening retinal diseases. J Chin Med Assoc 2020; 83:962-966. [PMID: 32649414 PMCID: PMC7526587 DOI: 10.1097/jcma.0000000000000382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A suitable fundus camera for telemedicine screening can expand the scale of eye care service. The purpose of this study was to compare a handheld nonmydriatic digital fundus camera and a conventional mydriatic fundus camera according to the image quality of their photographs and usability of those photographs to accurately diagnose various retinal diseases. METHODS A handheld nonmydriatic fundus camera and conventional fundus camera were used to take fundus photographs of outpatients at an ophthalmic clinic before and after pupillary dilation. Image quality and diagnostic agreement of the photos were graded by two masked and experienced retinal specialists. RESULTS A total of 867 photographs of 393 eyes of 200 patients were collected. Approximately 80% of photos taken under nonmydriasis status using the handheld nonmydriatic fundus camera had good (55.7%) or excellent (22.7%) image quality. The overall agreement of diagnoses between the doctors was more than 90%. When the handheld nonmydriatic fundus camera was used after mydriasis, the proportion of images with good (45%) or excellent (49.7%) quality reached 94.7% and diagnostic agreement was 93.4%. Lens opacity was associated with the quality of images obtained using the handheld camera (p = 0.041), and diagnosis disagreement for handheld camera images was associated with preexisting diabetes diagnosis (p = 0.009). Approximately 40% of patients expressed preference for use of the handheld nonmydriatic camera. CONCLUSION This study demonstrated the effectiveness of the handheld nonmydriatic fundus camera in clinical practice and its feasibility for telemedicine screening of retinal diseases.
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Affiliation(s)
- Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yueh-Hua Chiang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Lu Hsu
- Medimaging Integrated Solution Inc., Hsinchu, Taiwan, ROC
| | | | - Yi-Ying Chen
- Medimaging Integrated Solution Inc., Hsinchu, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University Taipei, Taiwan, ROC
- Address correspondence. Dr. Shih-Jen Chen, Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (S.-J. Chen)
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Sommer AC, Blumenthal EZ. Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak. Graefes Arch Clin Exp Ophthalmol 2020; 258:2341-2352. [PMID: 32813110 PMCID: PMC7436071 DOI: 10.1007/s00417-020-04879-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose Technological advances in recent years have resulted in the development and implementation of various modalities and techniques enabling medical professionals to remotely diagnose and treat numerous medical conditions in diverse medical fields, including ophthalmology. Patients who require prolonged isolation until recovery, such as those who suffer from COVID-19, present multiple therapeutic dilemmas to their caregivers. Therefore, utilizing remote care in the daily workflow would be a valuable tool for the diagnosis and treatment of acute and chronic ocular conditions in this challenging clinical setting. Our aim is to review the latest technological and methodical advances in teleophthalmology and highlight their implementation in screening and managing various ocular conditions. We present them as well as potential diagnostic and treatment applications in view of the recent SARS-CoV-2 virus outbreak. Methods A computerized search from January 2017 up to March 2020 of the online electronic database PubMed was performed, using the following search strings: “telemedicine,” “telehealth,” and “ophthalmology.” More generalized complementary contemporary research data regarding the COVID-19 pandemic was also obtained from the PubMed database. Results A total of 312 records, including COVID-19-focused studies, were initially identified. After exclusion of non-relevant, non-English, and duplicate studies, a total of 138 records were found eligible. Ninety records were included in the final qualitative analysis. Conclusion Teleophthalmology is an effective screening and management tool for a range of adult and pediatric acute and chronic ocular conditions. It is mostly utilized in screening of retinal conditions such as retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration; in diagnosing anterior segment condition; and in managing glaucoma. With improvements in image processing, and better integration of the patient’s medical record, teleophthalmology should become a more accepted modality, all the more so in circumstances where social distancing is inflicted upon us. ![]()
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Affiliation(s)
- Adir C Sommer
- Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, 31096, Haifa, Israel
| | - Eytan Z Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, 31096, Haifa, Israel. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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