Eyeworld

SPRING 2025

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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96 | EYEWORLD | SPRING 2025 G UCOMA by Ellen Stodola Editorial Co-Director About the physicians Grayson W. Armstrong, MD, MPH Director of Ophthalmology Emergency Services Associate Director of Ophthalmology Medical Student Education Mass Eye and Ear Harvard Medical School Boston, Massachusetts April Maa, MD Director of the National Subspecialty Ophthalmology Network VISN 23 Clinical Resource Hub Minneapolis VA Healthcare System Eagan, Minnesota Professor of Ophthalmology Emory Eye Center Emory University School of Medicine Atlanta, Georgia D uring the COVID-19 pandemic, oph- thalmic practices turned to telemed- icine to be able to stay in contact with their patients and get them the care they needed. In this article, two physicians discussed their experience with tele- medicine, including how they saw its applica- tions evolve, how they're using it currently, and thoughts on the future potential of telehealth options in the field of ophthalmology. April Maa, MD Dr. Maa had experience with telemedicine before the COVID-19 pandemic. "When the pandemic hit, we already had the telehealth in- frastructure in place," she said. "Our telehealth infrastructure, because we're a national health- care system, was based at the primary care clinic, so that was helpful to help debulk the main eye clinic because the patients could go to a site that was smaller and less crowded and be seen there. That helped with social distancing and waiting." When the pandemic hit, Dr. Maa said care was able to continue in primary care clinics with extra precautions and cleaning. After the pan- demic, the same work continued, but Dr. Maa said they expanded the amount of work that they were doing via telehealth because of the workforce shortage that made access to eyecare tighter. The telehealth sites alleviated some of this stress. "We swapped out some equipment we had at our primary care clinics and made that eyecare access point capable of doing more advanced testing. Before we were only doing glasses and screenings, and now we're doing even more—visual fields, OCTs—so for people who have disease, we are able to care for them as well," Dr. Maa said. Dr. Maa said her center has begun using telehealth for subspecialty care, e.g., retina, spe- cifically managing medical ophthalmology cases that are non-procedural. Currently, they're using telemedicine for screening and glasses, glau- coma follow-ups, retina follow-ups (dry AMD, epiretinal membrane), and they are exploring options for telehealth methods in non-urgent neuro-ophthalmology cases. "We're using it for any condition in which we know that the testing we can get at the telehealth site would be equivalent to the testing we would get in the clinic and following that up with a phone call or video call to convey the results after everything is tested. "The way our system is set up is there's an ophthalmology clinic in the main hospital, then there's satellite primary care clinics, and those primary care clinics can be far away from the main hospital, 3–4 hours depending on which region of the country you're looking at," she continued. Patient monitoring at primary care clinics can allow them to track vision changes to know when the patient needs to see a doctor at a specific eyecare clinic. "We're helping to take care of more patients and save them the travel." Dr. Maa said communication with patients is key, and lessons learned have improved this over time. "We have done some improvements in which we make sure the patient gets a hand- out that tells them what the next steps are," she said, adding that her telehealth hub has set up their own call center. "If we call them and are unable to reach them, we can now give them a centralized phone number, and they're able to call that number back so they can be educated about what's going on with their eyes. If they want to talk to the doctor again, it's a way to let the doctor know that the patient wants to speak with them. It helps facilitate continuity after the telehealth visit." Additionally, Dr. Maa said they have recent- ly been looking at sustainability and impact on health equity. "We've been looking at the cost effectiveness of this process," she said. This in- cludes how many patients are reached and what patients are getting diagnosed within the rural communities. That information was gathered across the country and has recently been pub- lished in Ophthalmology. 1 The paper illustrated that rurality is the number one risk factor for eye disease severity and burden of eye disease and showed that the telehealth sites promoted health equity while also being sustainable after seed funding ended. Looking to the future, Dr. Maa said she'd like to be able to incorporate a slit lamp exam. "If we were able to get that done, we'd be able to manage some more anterior segment The evolution of telemedicine in ophthalmology continued on page 98

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