An algorithm in ophthalmic emergencies to evaluate the necessity of physical consultation during COVID-19 lockdown in Paris: Experience of the first 100 patients

Purpose

This study aimed to evaluate the ability of a freely accessible internet algorithm to correctly identify the need for emergency ophthalmologic consultation for correct diagnosis and management.

Method

This retrospective observational cohort study was based on the first 100 patients who requested recommendations on the necessity of breaking the lockdown for emergency ophthalmology consultation during the period from March to May 2020.

Results

Ninety-one patients completed questionnaires. Forty-nine were directed to emergency consultation and 42 to differed scheduled visits or telemedicine visits. One patient sent for emergency consultation had an overestimated severity and could have been seen later, while two patients initially recommended for a scheduled visit were considered appropriate for emergency consultation. However, these patients’ management did not suffer as a consequence of the delay. The sensitivity of the algorithm, defined as the number of emergency consultations suggested by the algorithm divided by the total number of emergency consultations deemed appropriate by the practitioner's final evaluation, was 96.0%. The specificity of the algorithm, defined as the number of patients recommended for delayed consultation by the algorithm divided by the number of patients deemed clinically appropriate for this approach, was 97.5%. The positive predictive value, defined as the number of appropriate emergency consultations divided by the total number of emergency consultations suggested by the algorithm, was 97.9%. Finally, the negative predictive value, defined as the number of appropriately deferred patients divided by the number of deferred patients recommended by the algorithm, was 95.2%.

Conclusion

This study demonstrates the reliability of an algorithm based on patients’ past medical history and symptoms to classify patients and direct them to either emergency consultation or to a more appropriate deferred, scheduled appointment. This algorithm might allow reduction of walk-in visits by half and thus help control patient flow into ophthalmologic emergency departments.

Teleconsultation in primary ophthalmic emergencies during the COVID-19 lockdown in Paris: Experience with 500 patients in March and April 2020

This prospective observational cohort study is based on the first 500 patients who requested emergency teleconsultation during the initial days of the COVID-19 lockdown in Paris, France between 20 March and 10 April 2020. It is the first study to assess the utility of emergency teleophthalmology with a simple smartphone application or web browser and a webcam to manage emergency eye care in a population with sudden restricted access to ophthalmologists. In this study, every patient who asked for an ophthalmic emergency consultation in a single specialized center in Paris (‘SOS Œil’) first had to undergo a teleconsultation appointment to evaluate the indication for a physical consultation to preserve lockdown. Under medical advice only, a physical appointment was given within a day (if necessary). The aim of the study was to describe the population and diagnoses and evaluate the main judgment criteria, defined as the ‘ability of teleconsultation to properly indicate a physical consultation for fair diagnosis and treatment in eye emergencies’. This organization has permitted physicians and patients to preserve social distancing while avoiding 3 or 4 physical consultations per person. Notably, 27% of teleconsultations were followed by a physical appointment. There was a mean 4.12-day delay between symptom apparition and consultation, and less than 1 day for traumas, superficial corneal foreign body and neuro-ophthalmological emergencies. There was a 96% sensitivity and 95% specificity to properly evaluate the indication of a physical consultation and only 1.0% misdiagnoses that lead to delayed care. Hence, teleconsultation maintained satisfactory healthcare access to patients with severe ophthalmological disorders while preserving social distancing and sanitary precautions. Therefore, teleconsultation may be seriously considered as a way to efficiently regulate ophthalmic emergencies, especially for patients with limited access to a specialist.