Eyeworld

N MAY 2020 | EYEWORLD | 39 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 a link to my waiting room vs. spending time teaching them how to find the App Store. We also like that it's device agnostic, Apple and Android are both supported, and it allows us to invite multiple patients at once into a virtual waiting room," he said. "This way patients can wait for us to bring them from the virtual waiting room to the exam vs. my team spending time trying to call each patient and invite them in the waiting room one by one, which is inefficient. We can take anterior segment photos with it, and all of our provid- ers have been able to take to it easily." So far, they've even caught a COVID-19 patient who presented with conjunctivitis. "A lot of physicians wonder, if you can't do a slit lamp exam or check pressure, is it worth it?" Dr. Williamson said. "The answer is yes. It doesn't replace an in-person exam, but when you are practicing what we call 'wartime oph- thalmology,' anything is better than nothing. We think checking on patients to make sure their family is safe and not in need of medical atten- tion is important. Refilling medical prescriptions is of great value as well. If nothing else, just reaching out to your patients and making sure they know you're thinking about them and are still open for emergencies is important. Often we are the only doctors who have called them, so we take a moment to discuss general safety guidelines for COVID. Keeping our practice in patients' minds and keeping our doctors' minds on their patients is critical during a crisis." continued on page 40 Christina Weng, MD Associate professor of ophthalmology Cullen Eye Institute, Baylor College of Medicine Houston, Texas Working as a surgical retina specialist in an academic setting, Dr. Weng finds several chal- lenges that telemedicine can't quite overcome: 1) patients who need injections, 2) urgent and emergent pathology, and 3) cameras and equip- ment needed to assess the retina and posterior segment. Dr. Weng still sees most of her injection patients, critical postoperative follow-ups, surgi- cal complications, and patients who are experi- encing acute symptoms (flashes, floaters, pain, vision loss, or eye redness). The clinic is taking precautions when carrying out those visits. Dr. Weng champions a large teleretinal screening program for diabetic retinopathy in Houston, Texas, but telemedicine in the COVID-19 era is different. The ultimate aim is to provide contactless care, she said. Ophthal- mologists are turning to platforms like Face- Time and Zoom that allow for video calls. At her institute, they are using televisits built into the EHR system and are able to bill for these exchanges. Additionally, the EHR has a mobile version that can be downloaded. Most of the "visits" involve the patient describing their symptoms and history, but people are getting innovative with evaluation methods, she said. "While the quality of images across a phone or computer camera will not parallel that from a slit lamp, it does allow for a general assessment and more-informed triage," Dr. Weng said. Another challenge is some elderly patients are not familiar with computers, smartphones, and apps, and some may not have access to these. For these patients, phone calls may be a better option than video chats, Dr. Weng said. "This type of telemedicine has been available for quite some time, but it was seldom used until COVID-19 forced us to change the

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