EyeWorld Asia-Pacific June 2021 Issue

FEATURE 8 EWAP JUNE 2021 by Sharita Siregar, MD Contact information Siregar: doktertasha@gmail.com On 10 December 2020, the APACRS and Asia Cornea Society (ACS), in collaboration with the Association of Eye Banks of Asia (AEBA), conducted a webinar on “Corneal Conundrums During COVID-19.” This article is based on the talk given by Sharita Siregar, MD, Cornea Consultant and Ophthalmologist, Jakarta Eye Center, Jakarta, Indonesia, on “Virtual Cornea Clinic: Expanding to meet your needs in the era of COVID-19.” Virtual Cornea Clinic keeping COVID-19 at a distance A t her talk at the APACRS and Asia Cornea Society (ACS) Webinar on “Corneal Conundrums during COVID-19,” Sharita Siregar, MD, Cornea Consultant and Ophthalmologist, Jakarta Eye Center (JEC), Jakarta, Indonesia, said that telemedicine—derived from the Greek tele for “far of” or “distance”—was developed by NASA in the 1960s. The term, then and now, was defined as the use of electronic information and communications technologies to provide and support healthcare at a distance. This technology branched into tele-ophthalmology in 1990, but at the time remained mainly focused on retina. Then the COVID-19 pandemic happened, arriving in Singapore on 23 January 2020 and in Indonesia on 2 March 2020. (For a more detailed description of events at the beginning of the pandemic, see “Eye banking challenges in the COVID era: Adapt and Overcome” in this issue.) In response, Dr. Siregar and cornea specialists from the two countries collaborated to develop and establish a new way of doing corneal consultation: the Virtual Cornea Clinic. Virtual collaboration The JEC, as member of the Asia-Pacific Tele-Ophthalmology Society (APTOS), full member of the World Association of Eye Hospitals (WAEH), and co-founder of the ASEAN Association of Eye Hospitals, had already established its JEC@cloud telemedicine setup in March 2020 to allow patients, who were afraid for their safety amid the pandemic, to consult their doctors without physically going to the hospital. Following the establishment of a “Circuitbreaker” beginning 3 April 2020, quickly evolving into large-scale social restrictions and travel restrictions beginning 6 April 2020, Dr. Siregar and her JEC colleagues collaborated with Donald Tan, MD, and his team at the Singapore National Eye Centre (SNEC) to develop the Virtual Cornea Clinic (VCC) for post-transplant patients, launching on 23 June 2020. “As we all know the patient post transplant needs to be observed frequently and continuously,” Dr. Siregar said. Their patients at the time were mainly Dr. Tan’s post- corneal transplant patients, and virtual clinic was set-up to check visual acuity and IOP; perform slitlamp examination; follow-up on graft condition, checking for infection, rejection, or failure, and performing an endothelial cell count and AS-OCT as needed; and on the patient’s compliance to and existing supply of medication. Setup, benefits, barriers Aside from the technological requirements for any virtual office setup—including computers, audio-video equipment, and a high-speed internet connection—a Virtual Cornea Clinic requires a full complement of personnel apart from the cornea doctors, including the Leader/Head of Tele-ophthalmology service, IT support, assistants/ nurses, registration/call center personnel, and finance personnel. The setup allows patients to be “directly”, in real-time, seen by the surgeon who performed the surgery even amid the unsafe conditions to the pandemic. In addition, due to the collaborative and remote virtual setup, the patient can get not just one but two professional opinions at once, gather relevant family members together in the same consultation, and even check on the patient’s medical supplies at home, all while protecting them against contagion. Citing a study conducted by Sharma et al. in 2020 1 , Dr. Siregar said that teleophthalmology is suitable for patients with red eye but normal vision; for follow-up for medicine optimization post surgery with no complaints; counseling for LASIK and conditions such as diabetic retinopathy, glaucoma, cataract, dry eye, and others; to discuss difficult cases with other ophthalmologists; to provide first aid in emergency cases. The study further found that teleophthalmology reduced Sharita Siregar, MD, Indonesia Consultant Ophthalmologist JEC Eye Hospitals and Clinics