EyeWorld Asia-Pacific September 2020 Issue

NEWS & OPINION EWAP SEPTEMBER 2020 55 a link to my waiting room vs. spending time teaching them how to find the App Store. We also like that it’s device agnostic, Apple and Android are both supported, and it allows us to invite multiple patients at once into a virtual waiting room,” he said. “This way patients can wait for us to bring them from the virtual waiting room to the exam vs. my team spending time trying to call each patient and invite them in the waiting room one by one, which is inefficient. We can take anterior segment photos with it, and all of our providers have been able to take to it easily.” So far, they’ve even caught a COVID-19 patient who presented with conjunctivitis. “A lot of physicians wonder, if you can’t do a slit lamp exam or check pressure, is it worth it?” Dr. Williamson said. “The answer is yes. It doesn’t replace an in-person exam, but when you are practicing what we call ‘wartime ophthalmology,’ anything is better than nothing. We think checking on patients to make sure their family is safe and not in need of medical attention is important. Refilling medical prescriptions is of great value as well. If nothing else, just reaching out to your patients and making sure they know you’re thinking about them and are still open for emergencies is important. Often we are the only doctors who have called them, so we take a moment to discuss general safety guidelines for COVID. Keeping our practice in patients’ minds and keeping our doctors’ minds on their patients is critical during a crisis.” Christina Weng, MD Associate professor of ophthalmology Cullen Eye Institute, Baylor College of Medicine Houston, Texas Working as a surgical retina specialist in an academic setting, Dr. Weng finds several challenges that telemedicine can’t quite overcome: 1) patients who need injections, 2) urgent and emergent pathology, and 3) cameras and equipment needed to assess the retina and posterior segment. Dr. Weng still sees most of her injection patients, critical postoperative follow-ups, surgical complications, and patients who are experiencing acute symptoms (flashes, floaters, pain, vision loss, or eye redness). The clinic is taking precautions when carrying out those visits. Dr. Weng champions a large teleretinal screening program for diabetic retinopathy in Houston, Texas, but telemedicine in the COVID-19 era is different. The ultimate aim is to provide contactless care, she said. Ophthalmologists are turning to platforms like FaceTime and Zoom that allow for video calls. At her institute, they are using televisits built into the EHR system and are able to bill for these exchanges. Additionally, the EHR has a mobile version that can be downloaded. Most of the “visits” involve the patient describing their symptoms and history, but people are getting innovative with evaluation methods, she said. “While the quality of images across a phone or computer camera will not parallel that from a slit lamp, it does allow for a general assessment and more- informed triage,” Dr. Weng said. Another challenge is some elderly patients are not familiar with computers, smartphones, and apps, and some may not have access to these. For these patients, phone calls may be a better option than video chats, Dr. Weng said. “This type of telemedicine has been available for quite some time, but it was seldom used until COVID-19 forced us to change the way we work and live,” Dr. Weng said, adding that she thinks this shift in providing care will be a permanent one. “I hope that this brings a heightened awareness to the value of conventional, fundus- based teleretinal screening, a cost-effective way to prevent blindness in millions of people.” April Maa, MD Associate professor Emory Eye Center, Emory University School of Medicine Clinical director of TECS, VISN 7 Regional Telehealth Service Atlanta VA Medical Center Decatur, Georgia Dr. Maa works with the VA, which had a telemedicine screening program prior to the pandemic, Technology-based Eye Care Services (TECS). The goals of TECS were to prescribe glasses and identify patients requiring an in-person eye exam at the primary medical care home. Challenges in the VA system pre- pandemic included geography (patients living far away from the main eye clinics) and access (not enough appointment availability). However, since the COVID-19 pandemic, her focus has shifted, since many of the veterans are high risk, and TECS requires a technician to be present in person with the patient. “Routine eye screenings don’t need to be done during this time,” Dr. Maa said. “We’ve shifted our experience in telemedicine to helping the field find another way to see patients during the pandemic.” She mentioned a newly designed video protocol to connect with patients and added that they are piloting a protocol for ophthalmic urgent care, which allows for a specialist to be patched in through the VA Video Connect system if, for example, a primary care doctor has an eye question when seeing a patient via video appointment. Post-COVID-19, there’s going to be a substantial backlog because many patients who need care but are not having acute problems are not being seen at this time. There may be the possibility to do a “digitally integrated visit,” where a technician could perform tests and check on the patient in the office, even if the physician isn’t present, and the physician could follow up with the patient after all the information is gathered, Dr. Maa said. “It’s unfortunate that the pandemic is here, but at the same time, it’s a good opportunity for practices to incorporate telemedicine as part of their toolbox for taking care of patients,” Dr. Maa said, adding that it’s an important tool for being successful in the long run. EWAP