Inpatient Virtual Vision Clinic Improves Access to Vision Rehabilitation Before and During the COVID-19 Pandemic.

Keilty, Matthew; Houston, Kevin E.; Collins, Caroline; Trehan, Ritika; Chen, Ya-Ting; Merabet, Lotfi; Watts, Amy; Pundlik, Shrinivas; Luo, Gang

Objective To describe and evaluate a secure video call system combined with a suite of iPad vision testing apps to improve access to vision rehabilitation assessment for inpatients. Design Retrospective. Setting Two acute care inpatient rehabilitation hospitals (AR1 and AR2) and 1 long-term acute care hospital (LTAC). Participants Records of inpatients seen by the vision service Interventions Records from a one-year telemedicine pilot performed at AR1 and then expanded to AR2 and LTAC during COVID-19 were reviewed. In the virtual visits, an occupational therapist (OT) measured the patients’ vision with the iPad apps and forwarded results to the off-site Optometrist (OD) for review prior to a video visit. The OD provided diagnosis and education, press-on prisms, strategies and modifications, and follow-up recommendations. Providers completed the telehealth usability questionnaire (10-point scale). Main Outcome Measure(s) Vision exams per month at AR1 before and with telemedicine. Results With telemedicine at AR1, mean visits per month significantly increased from 10.7 ± 5 to 14.9 ± 5 (p=0.002). Prism was trialed in 40% of cases of which 83% were successful, similar to previously reported in-person success rates. COVID-19 caused only a marginal decrease in visits per month (p = 0.08) at AR1, whereas the site without an established program (AR2) had a 3-4 week gap in care while the program was initiated. Cases at the LTAC tended to be more complex and difficult to manage virtually. The telehealth usability questionnaire median category scores were 7 for Ease of Use, 8 for Interface Quality, 6 for Reliability, and 9 for Satisfaction and Future Use. Conclusion(s) The virtual vision clinic process improved inpatient access to eye and visual neuro-rehabilitation assessment before and during the COVID-19 quarantine and was well accepted by providers and patients.