EyeWorld India September 2020 Issue

NEWS & OPINION 54 EWAP SEPTEMBER 2020 Contact information Baartman: brandon.baartman @vancethompsonvision.com Maa: amaa@emory.edu Ristvedt: deborah.ristvedt @vancethompsonvision.com Weng: Christina.Weng@bcm.edu Williamson: blakewilliamson@weceye.com This article originally appeared in the May 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. by Ellen Stodola Editorial Co-Director Bringing telemedicine into practice T elemedicine in practices has grown exponentially in light of the COVID-19 pandemic. EyeWorld spoke with ophthalmologists around the country about their implementation of telemedicine and how it’s allowing them to help patients while clinic and surgical services are limited. Deborah Ristvedt, DO Vance Thompson Vision Alexandria, Minnesota Brandon Baartman, MD Vance Thompson Vision Omaha, Nebraska Having not previously used telemedicine, Dr. Ristvedt said that Vance Thompson Vision began diving into best practices in mid-March, learning how to make it work for their patients, especially for the elderly patient population. Doctors at the practice strategized and broke into teams, each addressing different issues, with Dr. Ristvedt focusing on how to make the best telemedicine program possible. The practice now has a “robust telemedicine program,” seeing patients in the office for testing only; a doctor follows up later via a video or phone call. For glaucoma patients, Dr. Ristvedt said there may be a possibility for virtual visual field tests or IOP checks. Similarly, plastics patients could potentially do a virtual visual field test. While photographs can be taken and analyzed with telemedicine, Dr. Ristvedt said, one hurdle is pressure monitoring. There are technologies available for remote IOP monitoring, but they haven’t been implemented across the nation. Telemedicine services are keeping the practice moving during the pandemic, but Dr. Ristvedt added that there is some concern about volume when practices reopen as well, and these methods may still be useful then. Dr. Ristvedt said that patients being seen in the office are those who require a slit lamp exam or retina evaluation. These could include patients who recently had glaucoma surgery or those who are experiencing flashes or floaters after cataract surgery. Dr. Baartman said that he’s still seeing patients scheduled for essential postoperative care (like glaucoma surgical patients or corneal transplants) as well as ongoing, sight-threatening issues like corneal ulcers. One of the goals moving forward is to limit not only the number of in-person visits but also the amount of time each patient spends in the office. A lot is dependent on in-person diagnostics and slit lamp examination, making a true “telemedicine” program challenging, he said. Dr. Baartman described a “hybrid program,” where necessary testing is done in person but follow-up with the doctor is conducted afterward by phone or video. They’ve also implemented a system so all new patients can elect to be seen by a doctor virtually. “In creating this hybrid program, we want to implement something that can be sustainable,” Dr. Baartman said. “We do not know for how long we will need to be instituting some of these changes, so we think it’s important to create something that is functional and not onerous to staff or doctors.” Blake Williamson, MD Williamson Eye Center Baton Rouge, Louisiana In response to COVID-19, Dr. Williamson quickly transformed his practice into a virtual eyecare center with 10 of the 14 doctors at Williamson Eye participating in telemedicine. From day 1 his goal was to make this a robust, patient- friendly experience that allowed the doctors to take care of a relatively high volume of patients. By the second week, they were approaching around 100 telemedicine consults per day. “At first, we had some issues with patient acceptance as many were intimidated by the technology,” Dr. Williamson said. “Our call center also struggled somewhat with how to explain the benefits of telemedicine to patients. But with careful scripting of our teams working the phones, we were able to overcome this, and our patients have enjoyed the opportunity to get their eyecare needs and prescription refills taken care of from the comfort of their homes.” Williamson Eye is using Doxy. me, which Dr. Williamson chose because he found it to be the simplest platform. “We like that Doxy is web-based, which means it doesn’t require the patient to download an app. Instead we can simply text them