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COMMENTARY
Year : 2020  |  Volume : 58  |  Issue : 2  |  Page : 89

Teleophthalmology during COVID times


Department of Glaucoma, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India

Date of Submission24-May-2020
Date of Acceptance28-May-2020
Date of Web Publication17-Jun-2020

Correspondence Address:
Dr. Ronnie George
Department of Glaucoma, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_62_20

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How to cite this article:
George R. Teleophthalmology during COVID times. TNOA J Ophthalmic Sci Res 2020;58:89

How to cite this URL:
George R. Teleophthalmology during COVID times. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Aug 10];58:89. Available from: http://www.tnoajosr.com/text.asp?2020/58/2/89/286941



The coronavirus disease-2019 (COVID-19) epidemic has had a huge impact on ophthalmology practice. As per the American Academy of Ophthalmology, it may be the hardest hit specialty in terms of reduction in case load. With the mandatory shutdowns, most centers are seeing only emergency cases and postoperative patients.

In the past, tele-ophthalmology has been successfully used in three modes: screening for disease, for diagnostic consultations, and for long-term follow-ups. Screening has been fairly successful for diseases such as diabetic retinopathy; however, in low-resource settings, there have been the challenges of getting good-quality images in eyes with media opacity. In a diagnostic setting in Canada for referred glaucoma patients, 69% of tele-glaucoma patients referred for suspected glaucoma could be managed by the referring primary eye-care provider and did not require in-person evaluation by a specialist. In long-term follow-up of glaucoma patients, there are “Virtual Glaucoma Clinics” in the United Kingdom where “stable” patients are followed through virtual review of glaucoma testing with in-person visits only when necessary. However, there have been differences in decision-making regarding when and where to review glaucoma patient, based on the data available.

In this setting, tele-ophthalmology is an attractive option. Unfortunately, ophthalmic practice in the COVID era brings with it certain challenges. In all the situations referred to above patient, clinical information was available in terms of a vision test, fundus image, intraocular pressure, or a visual field.

In the current situation with no access to any of these, tele-ophthalmology is limited to a tele-counseling where we can assist in terms of minor differences in medication, reassuring patients, and some degree of triaging deciding who needs to go to a hospital immediately. At Sankara Nethralaya, a tele-consultation platform is made available where summary of data from the electronic medical records was made available to the doctor and patients could speak with the doctor through internet telephone or a video call depending on their preference. It was useful to communicate with postoperative patients in terms of instructions regarding tapering of medications. This could also help re-assure patients when there were obvious abnormalities, such as a subconjunctival hemorrhage, or as in the case of one patient who discovered that he had a filtering bleb 5 years after glaucoma surgery and became alarmed. In one situation where a previous patient of ours, currently not in Chennai, complained of acute-onset blurry vision and floaters, a rough assessment of vision was possible, and based on his previous records which were suggestive of asymptomatic healed choroiditis, one could immediately suggest an urgent consult with an ophthalmologist.

There are definite challenges in using tele-ophthalmology in the current phase of the COVID pandemic since access to instrumentation and clinical data is challenging. However, once the lockdowns are relaxed, we will have to restart clinical services with appropriate social distancing.

In this phase, centers with multiple branches or peripheral centers could possibly reduce patient and physician travel by leveraging the advantages offered by tele-ophthalmology. This will be dependent on having adequate infrastructure and trained personnel at each site.






 

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