Teleophthalmology: An Essential Tool in the Era of the Novel Coronavirus 2019

Meghana Kalavar; Hong-Uyen Hua; Jayanth Sridhar

Disclosures

Curr Opin Ophthalmol. 2020;31(5):366-373. 

In This Article

Integrating Teleophthalmology Into Office-visit Workflows

Many aspects of an office-based visit can take place over real-time video consultation (Figure 1a). By examining the patient over video conference, the ophthalmologist can assess pupils, alignment, corneal light reflexes, ocular motility, and perform an external examination of the eye, eyelids, and adnexa.[33] Combined with a detailed history, the ophthalmologist is able to diagnose a host of eye disorders, particularly those of the adnexa. Consequently, ophthalmic subspecialties that rely more heavily on examination of the adnexa, such as oculoplastics, neuro-ophthalmology and pediatric ophthalmology are more amenable to these types of visits.[33] Numerous validated apps also exist online to aid in providing diagnostic tools from home. Some functions of these apps include testing visual acuity, color vision, astigmatism, metamorphopsia, pupil size, and oculomotor reflexes.[34–39] Lastly, portable devices are being developed to allow for more complex imaging such as optical coherence tomography, fundus photography, and scanning laser ophthalmoscopes, that can be done at home for a relatively low cost.[40–42] Although further studies need to be conducted before they can be used at home, they provide promise of increased capacity to utilize teleophthalmology from home in the future.

Figure 1.

Describes how telemedicine can be seamlessly integrated into (a) ophthalmology practice workflows and (b) emergency department workflows.

Some diagnostic maneuvers utilized in ophthalmology centers are more difficult to replicate in a home setting such as a slit-lamp exam, dilated fundus exam, or measurement of intraocular pressure. However, even in these situations, store and forward and real-time visit modalities can be integrated to limit exposure. For example, the patient can initially have a video visit with the provider, determine the necessary in-person components, and then come into the office for expedited and focused testing. The images or measurements can be sent to the physician to review (store and forward). Technologies also exist to utilize these hybrid visits in real-time. For example, a robotic remote-controlled stereo slit-lamp allows ophthalmologists to have complete control of optic and mechanical components while viewing and recording the slit lamp examination remotely.[43,44] This technology may also be useful in patients that have ocular diseases managed by several subspecialties as multiple providers can view the examination simultaneously.[45] These hybrid teleophthalmology visits decrease the number of staff required on-site, minimize exposure to clinicians and patients, and conserve medical supplies. Although teleophthalmology cannot completely replace in-person office visits, innovative technology enables many aspects of the in-person office visits to be performed remotely and extend the scope of the practice to the home.

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