Outlook is bright for telemedicine in ophthalmology

Reviewed by Saya Nagori, MD.

The landscape in the tele­medicine arena has changed markedly within a dramatically short period. In 2015, telemedicine technology was rela­tively uncharted, as physicians were re­luctant to engage and many states had unclear rules about its use.

Over the past year, the COVID-19 pan­demic has significantly impacted the US healthcare landscape. While it is too early to determine the long-term impact, the ophthalmology industry has seen proof of innovation and widespread changes in reimbursements and service modalities.

The big question was how telemedicine could mimic the in-person examination, according to Saya Nagori, MD, vice president of medical affairs and founder of SimpleHealth.com and owner of VisionMD.co.

In 2015, telemedicine faced legislative battles, regulatory hur­dles, confusing/limited reimburse­ments, and low adoption rates by physicians and patients, Nagori said.

Now, there has been a major reversal. Since the onset of the COVID-19 pandemic, patients and physicians have embraced telemedi­cine, physicians have been receiving reimburse­ments since March 2020, and regulatory issues are no longer problematic.

“The biggest misconception holding physicians back is the notion that physicians must address every issue via telemedicine,” Nagori said.

Related: How telemedicine is forging a new chapter in eye care

Making the team approach work

Telemedicine seems tailor-made to replace in-person visits for patients needing chronic care; however, it is not as appropriate for acute care, Nagori said.

Getting the clinic staff on board is one of the biggest challenges.

“When each member of the team can handle almost all of what is needed during a virtual examina­tion, this will facilitate a seamless transition to telemedicine. Physi­cians need to help the team mem­bers understand what can and can­not be accomplished via telemedi­cine,” Nagori explained.

Related: Screening DR + tele-ophthalmology AI: Less expensive than human assessment

Examinations

Ocular pathologies that can be di­agnosed and managed successfully via telemedicine include chalazion, stye, and lid lesions; episcleritis; dry eye; subcon­junctival hemorrhages; ocular allergies; conjunc­tivitis; myopia, hyperopia, and astigmatism; and pterygium and pinguecula; in addition patients with acute angle closure and retinal detachment may be triaged.

After the COVID pandemic eases, telemedicine’s place in the practice will continue to be convenient for physicians working from home, and when patients are in the office or at a remote testing center.

Related: Spotlighting telemedicine in the year of a pandemic

Innovations

Telehealth also lends itself to disease detection. NGoggle technology (Ngoggle Diagnostics) senses brain activity using electroencephalography (EEG) through neurostim­ulation and feedback. The patient wears a headset with a virtual reality goggle that contains EEG sen­sors and custom optics that can measure disease progression remotely.

Felipe Medeiros, MD PhD, vice chairman of the Department of Oph­thalmology at Duke University School of Medicine in Durham, North Car­olina, and colleagues designed this innovative technology with the goal of measuring visual fields more often to prevent disease progress.

Amid the continuing challenges of telemedicine, it is vital to develop these developing technologies to pro­vide the best care for patients.

“The use of telemedicine is grow­ing. While it currently has its limitations within ophthalmology, the use case scenarios will con­tinue to expand with innovation and time,” Nagori concluded.

Related: Implementing at-home monitoring for exudative AMD

SAYA NAGORI, MD

e: saya.nagori@gmail.com

This article is adapted from Nagori’s presentation at the Ohio Ophthalmological Society’s 2021 virtual annual meeting. Nagori is a medical adviser to DOT Glasses.

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