We’d all like to be beside the sea . . . we’d all like to be exiting the lockdowns caused by the pandemic . . . you get the picture. It would be pretty fantastic if we could all get back to normal.
Lockdowns are still in place in most countries — so, sadly, for most of us, songs about the seaside are as close as we’re going to get to beaches and waves. Many also desperately want to get back to their clinics and resume regular ophthalmology. This at least is becoming easier to facilitate thanks to an increase in telemedicine uptake.
Telemedicine has emerged as a hero during the coronavirus pandemic. Uptake has increased exponentially since the crisis began and the technology is now having a beneficial impact in several sectors of ophthalmology — mainly in primary patient care. According to one recent study, telemedicine could allow clinicians to screen patients and continue routine treatments1 in high volume environments like emergency rooms. The lessons learned are increasingly being applied to ophthalmology.
The ophthalmology industry is abuzz with discussion about telemedicine. The consensus is that while telemedicine cannot replace surgery, it does offer considerable efficacy in a number of areas. What’s more, developments in telemedicine technology made during the coronavirus crisis may facilitate its growth into areas like surgery in the future.
Lessons from the Desert
Dr. Igor Kozak is a consultant ophthalmologist and a specialist in vitreoretinal surgery and uveitis. Working at Moorfield Eye Hospital’s satellite facility in Abu Dhabi, United Arab Emirates (UAE), Dr. Kozak has witnessed sweeping changes brought about by the coronavirus. While the UAE is a global travel hub, it has seen relatively few cases of the virus, which allows for interesting observations.
The UAE is currently reporting between 200-400 new cases of the virus per day, primarily among the country’s vast number of guest workers, who mostly live in squalid labor compounds. A strong testing regime is in place and hospitals have been re-focused entirely on coronavirus. Similar to other countries, most elective and non-urgent ophthalmic surgeries are cancelled.
Dr. Kozak reports that telemedicine is experiencing a major upsurge in interest in the UAE. Going beyond primary care, telemedicine is being used in a variety of areas, including to facilitate discussion on what procedures can and cannot continue. This discussion is international in scope and involves doctors across the region.
“Yesterday we had a webinar with representatives from Bahrain and Kuwait about what is elective . . . What was urgent before COVID-19 is also urgent now,” Dr. Kozak said.
“The patients with macular degeneration, acute glaucoma, retinal detachment should be treated. However, regarding cosmetic procedures like refractive surgery, I would just wait and see,” he said.
From Triage to Laser Treatment
The buzz about telemedicine in the Middle East is perhaps unsurprising. Uptake was already higher than in other global regions, with interest in the technology encouraged by governments and businesses alike. Telemedicine’s improved applicability during coronavirus, combined with an already receptive environment, makes it likely to be a permanent fixture of ophthalmology in the Middle East.
While recognizing that its primary role is diagnostic and not therapeutic, Dr. Kozak argues that telemedicine could have a therapeutic role in the future. He points to the results of study he co-authored in 2017 that concluded that it was safe and feasible to use telemedicine to perform navigated retinal laser treatments.2
“If a patient appears with conjunctivitis and they want to come in for follow-up, it can be done using telemedicine. This would be helpful for somebody with a sty or somebody using glaucoma eye drops,” Dr. Kozak said.
He expects the UAE to weather the coronavirus storm comfortably and that telemedicine will become a permanent, post-coronavirus. He expects this to alter triage methods and how insurance companies interact with clinics and patients. Dr. Kozak also believes that patients will welcome this development.
“Once the crisis is over, all those patients whose appointments were delayed will flock back, there will be a huge influx. According to one study in California,3 when offered the option, 80% of patients prefer telemedicine”, Dr Kozak said. “We have home monitoring devices for retinal diseases, which can check vision distortion. All of this is possible.”
Given the enthusiasm that is emerging for telemedicine, its long-term uptake is a welcome thing to look forward to, just like dreams of sitting by the seaside once again. While at the moment, we may continue to have a bleak outlook, there will be sunnier times ahead — in both ophthalmology and wider society — and not all of the changes we make will be negative.
Editor’s Note: This story is part of the new ‘Q&A from Quarantine’ series of PIE Talks, where Matt Young (CEO of Media MICE and Publisher of PIE and CAKE magazines), during the time of COVID-19 lockdown, reached out to KOLs and industry friends to evaluate and discuss the impact of this pandemic to the ophthalmic world.
References
- Rademacher NJ, Cole G, Psoter K, et al. Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine. JMIR Med Inform. 2019;7(2):e11233.
- Kozak I, Payne JF, Schatz P, et al. Teleophthalmology Image-Based Navigated Retinal Laser Therapy for Diabetic Macular Edema: A Concept of Retinal Telephotocoagulation. Graefes Arch Clin Exp Ophthalmol. 2017;255(8):1509-1513.
- Schallhorn SC, Hannan SJ, Teenan D, et al. Informed Consent in Refractive Surgery: In-Person vs Telemedicine Approach. Clin Ophthalmol. 2018;12:2459-2470.
