Tele-ophthalmology as an aid tool for primary care physicians in the IDF, during the Covid-19 lockdown

Abstract

Purpose To describe tele-ophthalmology consultations for primary-physicians in the IDF during the Covid-19 lockdown. Methods Retrospective cross-sectional study. Medical records of tele-ophthalmology consultations from March to June 2020 were reviewed. Results The study included 245 cases in which an ophthalmologist was consulted. In 62.0% cell-phone camera photographs were used. The mean age was 21.5 ± 6.4 years. The most common diagnoses were acute-conjunctivitis (8.6%); conjunctival-hyperemia (non-specific diagnosis, 8.2%); scleritis/episcleritis (7.3%); chronic allergic-conjunctivitis (7.3%); chalazion (7.3%) hordeolum (6.5%); acute allergic-conjunctivitis (4.5%). 37.6% of patients received primary physician-based treatment, 24.9% of patients received specialist-based treatment. 13.1% were referred to the ER. The consult prevented ER referral for 39.2% and changed the physician's treatment plan in 70.6% of cases. Foreign-body sensation complaints were more likely treated by a primary-physician ( p = 0.015). Cases with suspected foreign-body diagnosis were referred more to the ER ( p < 0.001). For most cases of eyelid complaints and diagnoses, primary physician care was sufficient ( p < 0.001). Conjunctival complaints and diagnoses received significantly more ophthalmologist-based treatment ( p < 0.001). Corneal disorders were significantly referred more to the ER ( p = 0.001). Conclusion Despite of possible ethical and legal problems and clinical limitations of this instrument, Tele-ophthalmology using objective aids such as smartphone photography can be an efficient tool in aiding the primary-physician, especially for patients with low access to ophthalmologists, with major impact on patient management.

Implementation of anterior segment ophthalmic telemedicine

“…Synchronous smartphone photographs and video have demonstrated high effectiveness in diagnosing external eye diseases, such as red eye complaints and postoperative eyelid complications [51,52]. Smartphones have also been used asynchronously to perform video consultations to aid emergency department (ED) physicians in addressing external eye complaints [53]. These virtual consultations reduced the need for emergency room referrals in 39.2% of cases and altered the physicians' treatment plans in 70.6% of instances [53].…”

“…Smartphones have also been used asynchronously to perform video consultations to aid emergency department (ED) physicians in addressing external eye complaints [53]. These virtual consultations reduced the need for emergency room referrals in 39.2% of cases and altered the physicians’ treatment plans in 70.6% of instances [53]. In a separate asynchronous care model utilizing patient questionnaires, smartphone and nonmydriatic fundus camera imaging, and ophthalmic vital signs, a telemedicine protocol achieved 71% sensitivity and 92% specificity in triage [54 ▪ ].…”

“…Ocular surface diseases are common complaints in telemedicine virtual visits [59 ▪ ]. Conditions reportedly evaluated via ophthalmic telemedicine include corneal ulcers [60], scars [61], pterygia [61], conjunctivitis [62], chalazion, hordeolum, and scleritis [53]. In a cross-sectional study among pediatric patients, asynchronous video-based examinations with a Topcon digital slit lamp (Topcon Corporation, Tokyo, Japan) showed substantial agreement between virtual and in-person care for cornea disease (sensitivity 88%, specificity 90%), while moderate agreement was noted for eyelid/eyelash disease (sensitivity 54%, specificity 92%) [63 ▪ ].…”