Telemedicine in oculoplastic and adnexal surgery: clinicians’ perspectives in the UK

Abstract

Background/AimsThe COVID-19 has facilitated a paradigm shift in the sphere of ophthalmic telemedicine: its utility is no longer limited to providing care to remote regions, rather it is expeditiously being adopted as the new standard of care. The aim of our paper is to explore the current attitudes of oculoplastic surgeons towards telemedicine and its utility in the present landscape and its prospects in the future.MethodsA 39-item questionnaire was distributed to consultant oculoplastic surgeons practising across the UK and anonymised responses were collected and analysed.ResultsThe COVID-19 pandemic has allowed rapid implementation of telemedicine services in oculoplastic departments across the UK with 86.6% of the respondents incorporating telemedicine into the routine clinical practice. Clinicians reported a statistically significant increase in utility of telemedicine, confidence in using telemedicine and quality of infrastructure available to employ telemedicine following the COVID-19 outbreak. The greatest utility of telemedicine is in triaging, postoperative assessment and eyelid lesion assessment. Main barriers to implementation of telemedicine included difficulties in conducting clinical examinations, lack of administrative support and poor access to digital technologies for patients. Overall, most clinicians were satisfied with the impact of telemedicine services and almost all experts foresee themselves continuing to use telemedicine in the future.ConclusionsTelemedicine has become an integral part of the oculoplastic service delivery since the COVID-19 pandemic its use is likely to continue. Further development of digital infrastructure and improvement of clinical examination capabilities are required to enable its wider adoption.

Impact and Challenges of Integrating Artificial Intelligence and Telemedicine into Clinical Ophthalmology

“…6 In the US, 59% of ophthalmologists admitted to "low confidence" in making a diagnosis based solely on imaging. 93 One way to overcome this is to use a "blended approach" which couples real-time video conferencing with asynchronous, storeand-forward image transmission to attenuate the issue of poor internet connectivity. 6,92 Despite low confidence in making remote diagnoses, a real-world retrospective cohort study evaluating safety of triaging emergency ophthalmology patients via teleophthalmology demonstrated patient safety comparable to in-person review at 1-month follow-up.…”

Automated extraction of clinical measures from videos of oculofacial disorders using machine learning: feasibility, validity and reliability

“…Indeed, it is estimated that almost 40% of new oculoplastic patient encounters and 60% of follow up appointments might be suitable for remote video consultation [ 4 ]. Conducted during the height of the pandemic’s first wave, nationwide surveys of oculoplastic surgeons in the UK and the USA demonstrated that 86.6–88.8% of respondents were incorporating telemedicine into their routine clinical practice [ 5 , 6 ]. Of those, about 85% were using a video-based platform to conduct remote consultation [ 6 ].…”

“…That said, there appear to be some important barriers to the widespread adoption of telemedicine in oculoplastics. Two-thirds of oculoplastic consultants remain dissatisfied by the limitations of clinical examination via telemedicine [ 5 ] and only 4% of surveyed surgeons felt comfortable proceeding to surgery based on remote consultation [ 6 ]. If video-based consultations are to provide the improvements in service delivery that are hoped for, we must strive for a standard of patient assessment that is at least comparable to that which we can provide face to face.…”

Telemedicine for Preoperative Evaluation of Upper Eyelid Malposition: Reliability of Diagnosis and Surgical Plan

“…A survey of oculoplastic surgeons found that among respondents in the United Kingdom, telemedicine was considered to be most useful for postoperative assessment, triaging, and eyelid lesion evaluation. 12 Visual field restriction due to upper eyelid malposition, including blepharoptosis (herein referred to as ptosis), dermatochalasis, and brow ptosis, is a common reason for referral to an oculoplastic surgeon. While most cases do not require urgent evaluation or treatment, these conditions can significantly affect patients' visual function and quality of life.…”

“…A survey of oculoplastic surgeons found that among respondents in the United Kingdom, telemedicine was considered to be most useful for postoperative assessment, triaging, and eyelid lesion evaluation. 12…”