Telehealth in eye care: Focusing on the benefits, meeting the challenges
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With the continued increase in the older patient population and a nearly 20% decline in the health care workforce, there is an urgent need to expand ocular telehealth, according to a speaker at the American Glaucoma Society meeting.
Yao Liu, MD, MS, shared an overview of telehealth models, their advantages and challenges, and advice on how to implement telehealth in the clinic.
After the WHO declaration of the COVID-19 pandemic, there was a dramatic reduction in in-person clinic visits that was accompanied by an initial massive expansion in telehealth, she said. However, this was followed by a rapid decline in the use of telehealth.
“Nearly 30% of all outpatient clinic visits across all specialties were provided using telehealth in April 2020. By the end of 2020, however, telemedicine accounted for a negligible proportion of ophthalmology visits,” Liu said. “This reflects the significant challenges our field faces in providing virtual care, including our reliance on slit lamp exams, as well as testing and imaging technologies that are traditionally office based.”
Other barriers to telehealth that emerged during the pandemic were unequal access to devices and broadband internet and the limited digital literacy of older adults and historically marginalized populations.
“While one of the goals of telehealth is to expand access to care, it can also worsen existing inequities and perpetuate biases,” Liu said.
Future directions for ocular telehealth include the need for continued advocacy, education and research into reimbursement policies along with equitable implementation. Research is also needed to rigorously establish the effectiveness and value of telehealth-based models as well as emerging technologies to improve anterior segment imaging and telemedicine-based laser and surgery, Liu said.
Finally, strategies are needed to engage and train key stakeholders.
“I-SITE — Implementation for Sustained Impact in Teleophthalmology — provides a coach-led process for engaging primary care personnel to integrate teleophthalmology into their daily work,” Liu said.
When piloted in 10 rural primary care clinics in the U.S., I-SITE led to a sustained 36% increase in diabetic eye screening over 2 years.
“We are now testing the generalizability of I-SITE in a multicenter clinical trial funded by the National Eye Institute,” she said. “We are also investigating the mechanisms that contribute to successful implementation as well as measuring health system costs.”
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Liu Y. A seagull’s eye view of telehealth in ophthalmology. Presented at: American Glaucoma Society meeting; Feb. 29-March 3, 2024; Huntington Beach, California (hybrid meeting).
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