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

Teleophthalmology for Specific Conditions

Prior to the COVID pandemic, the most established teleophthalmology models were for the screening and referral for diabetic retinopathy,[53] glaucoma,[54,55] and age-related macular degeneration (AMD).[56] In light of the rapid surge in demand for telemedicine, continuing to support and utilize teleophthalmology in these already established models is essential. Diabetic retinopathy was one of the first validated applications of teleophthalmology, and integration with artificial intelligence has made this method of screening even more accurate and cost-effective.[53,57] The Veterans Affairs program and Indian Health Service-Joslin Vision Network have successfully been running teleophthalmology based diabetic retinopathy screening for the past two decades.[58,59] Additionally, one study found that 69% of glaucoma patients seen via a teleophthalmology could be managed without an in-person consultation.[60] Food and Drug Administration (FDA) approved technologies monitoring intraocular pressure via a contact lens embedded with a microsensor, such as the Sensimed Triggerfish Sensor (Sensimed AG, Lausanne, Switzerland), have shown promising results in helping monitor this chronic condition through teleophthalmology.[32,61] Furthermore, the model of hybrid telehealth visits described above could also be implemented to conduct intraocular pressure (IOP) checks with minimal exposure. Finally, regarding AMD, physicians reached a similar assessment and treatment plan with ancillary testing and teleophthalmology as in-patient examinations 90% of the time.[62] Another option is FDA-approved telemonitoring devices such as the ForeseeHome (Notal Vision, Virginia, USA) and MyVisionTrack (Vital Art and Science, LLC, TX, USA), which can be used monitor the progression of degenerative eye disease daily. These devices send an alert to the physician if the patient's vision significantly changes.[41,63]

In children, teleophthalmology has been useful in diagnosing strabismus and retinopathy of prematurity (ROP). The gold standard for diagnosis of strabismus is the prism and cover test. However, studies have shown that clinicians were able to utilize store and forward technology to effectively diagnose, form a treatment plan, and perform surgical consent for strabismus using images taken on a low-cost camera.[64,65] For retinopathy of prematurity, the gold standard of diagnosis is through binocular indirect ophthalmoscopy[66] It is the leading cause of blindness in children and early treatment significantly reduces unfavorable outcomes.[66] There are several active successful tele-ROP screening programs across the country, with Stanford's SUNDROP program reporting close to 100% sensitivity rates in a retrospective analysis over six years.[67]

A recent report by Strata decision technology compared case volumes during a two-week period during the COVID pandemic to the same two-week period in 2019. The top five categories that saw case volume losses in ophthalmology during the COVID pandemic were cataract (97%), glaucoma (88%), eye and vision conditions (77%), retinal conditions (71%), and corneal conditions (71%).[7] Fortunately, as described above, teleophthalmology has the capacity and infrastructure necessary to address many of these issues, making this technology an invaluable tool during this pandemic.

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