Arman Mosenia, MD

New research published in JAMA Ophthalmology indicated the COVID-19 pandemic led to increased telehealth use across clinical specialties, with the lowest utilization observed in ophthalmology .

However, study investigator Tyson N. Kim, MD, PhD, Department of Ophthalmology, University of California, San Francisco, is quick to point out that while the rate was low relative to other specialties, ophthalmology relies heavily on exams and testing. An asynchronous testing approach proved effective for some subspecialty-level care.

“What is perhaps more interesting is that teleophthalmology was actually feasible with the hybrid approach, ” Kim said.

Although his department returned to mostly in-person visits, he noted that test-only visits were performed at the same location as in-person appointments. Thus, it became logistically easier to return to regular in-person visits in most situations as COVID-19 restrictions eased. Testing at other locations in the future could help determine the particular sustainability of the telehealth model.

In an accompanying Q& A along with HCPLive , study coauthor Arman Mosenia, MD, Department of Ophthalmology, Dell Medical School, The University associated with Texas in Austin, discussed the greater context from the team’s findings and the importance of innovative solutions to improve patient care within ophthalmology.

What factors played into the low use regarding telehealth observed in ophthalmology during typically the COVID-19 outbreak compared to some other specialties plus its greater subsequent return to in-person settings? How do these trends suggest this feasibility involving alternative treatment or telehealth within often the larger ophthalmic arena?

Ophthalmology relies heavily on examination in addition to testing. These data are typically acquired through real time encounters, creating intrinsic barriers for telehealth in ophthalmology. While our study did find that voluntary utilization connected with telehealth by physicians was lower in ophthalmology than other specialities, an important finding was that asynchronous testing really did make telehealth evaluation feasible. A limitation of our study was that it was not designed for continued use of telemedicine in ophthalmology beyond COVID-19 restrictions, as asynchronous testing was performed in your same buildings as in-person appointments. It was simply more convenient in most cases in order to return to be able to the traditional care model when COVID-19 restrictions were reduced. Using remote sites with regard to asynchronous testing will be a better way to assess if this telehealth care model is achievable long term.

Your data show subspecialties like retina and even glaucoma had been the lowest users of telehealth but have been some of the highest users regarding asynchronous testing. Moving forward, will hybrid care/asynchronous testing fill the niche of telehealth and benefit patient proper care for these subspecialties? Does the nature of these specialties requiring instrument-dependent eye examination lend credit to the hybrid model?

Physician participation in the hybrid telehealth model in our study was voluntary so we tried not to draw absolute conclusions upon its utility. For example, our retina division has been a low utilizer with telehealth, but ophthalmic telemedicine has traditionally been used most successfully in screening for retinal diseases. Nevertheless, we found that combining asynchronous testing with telehealth enabled the exact evaluation for certain conditions that had not previously been cared intended for remotely, highlighting new opportunities that lie ahead. Our work suggests that the hybrid design will be useful for most if not all subspecialties, together with we suspect the degree will be correlated with the quality and range of data obtained.

Accessibility is obviously a big question in any medical specialty. What are ways to better increase access for you to both asynchronous testing and additionally greater eye care for underserved populations who may advantage from this approach? What is the takeaway message on this topic?

The potential for telehealth to improve access to care is exciting. This could have significant impact in reaching underserved areas, particularly inside screening to get certain diseases and providing follow-up attention. One possible approach would be to bring screening sites directly to these communities to facilitate teleophthalmology, and then to refer abnormalities pertaining to in-person evaluation. It will also be important to learn and become cognizant about the blind-spots associated together with telemedicine, since we certainly don’t want to cause harm simply by missing disease.

Your findings highlight that the particular asynchronous screening approach may differ outside of the singular institution which included trained professionals in a fully equipped setting. Although possible, what more is required to evaluate the topic not to mention expand its reach in to these subspecialties?

This is an important question and area for innovation. The accessibility of remote control testing is likely inversely correlated towards the complexity and also cost in acquiring subspecialty-level data. Fortunately, there’s already been a lot of progress in making tools for getting this data more affordable as well as user-friendly. Additionally , the infrastructure on where to perform remote testing will need to be worked out. One possible method to expand testing in a controlled fashion may be to bring this screening for the primary care environment.

Moreover, why is this particular topic important, particularly given the far-reaching effects of typically the COVID-19 pandemic on individual care?

The COVID-19 pandemic forced us and the world to re-think healthcare delivery. This has catalyzed tremendous interest plus discussion in telemedicine, in addition to it’s a particularly impactful time to consider models which may or might not work.

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