Eyeworld

SPRING 2025 | EYEWORLD | 99 G References 1. Simon LS, et al. National expe- rience of Technology-based Eye Care Services: a comprehensive ophthalmology telemedicine initiative. Ophthalmology. 2024. Online ahead of print. 2. Aziz K, et al. Association of patient characteristics with delivery of ophthalmic tele- medicine during the COVID-19 pandemic. JAMA Ophthalmol. 2021;139:1174–1182. early or intermediate AMD, and ocular hy- pertension. Now there are people doing it for keratoconus or ectasia, or preop evaluations for LASIK. "I think it's a nice way to get clinical data that we need, and the video call is useful because you have clinical data in front of you, you can talk to the patient and show them the testing or images as if they're in the office, but it saves the patient time and effort, and it saves the physician time and effort, too." Dr. Armstrong thinks being part of a larger institution helped with telemedicine imple- mentation. "Because we were part of a big institution, Mass General Brigham, we had their support, so they quickly implemented a secure version of Zoom and Doximity that they encour- aged us to use for video and audio calls, and because of that, we didn't have to go searching for different platforms," he said. Dr. Armstrong said there was a lot learned from the experience of using telemedicine during the pandemic. After 2020, they had about 9 months of data. "We looked at all of the data from the year and tried to determine if the patients we were seeing with telemedicine were the same ones we were seeing normally in the office." He said this data was published in JAMA Ophthalmology. 2 It was found that telemedicine was more likely to be used by patients who were highly educated, white, English speakers, and women. There was a whole population of underserved and unrepresented populations that were not getting access to this, and it pushed the institution to adjust. "We integrated interpreter services to the system, and we educated our providers about this underrepresentation and let them know to try their best to see everyone," he said "We also realized that video calls were used more often by wealthier people, and audio calls were more frequently used for people of a poorer socioeco- nomic status because they might not have ac- cess to Wi-Fi at home, so we made it a priority to maintain audio-only visits, even if insurance companies rolled that back." Initially, Dr. Armstrong said the hybrid telemedicine approach needed to evolve be- cause the EMR being used wasn't set up to do a multiday visit, where there was the testing on one day and the visit on another. "Now we have a system where the patient can self-schedule the visit on the day they want and the virtual visit on a different day, and that's all connected in the EMR, so the billing works, too," he said. The theoretical issue is you're submitting a visual continued on page 100 The VECS technician positions the patient for a fundus photo and/ or OCT. Source: Amy Fox The VECS technician measures the pupillary distance of the patient as she fits the patient for glasses. Source: Amy Fox

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