Telehealth-based eye care during the COVID-19 Pandemic: Utilization, Safety and the Patient Experience

Newman-Casey, Paula Anne; De Lott, Lindsey; Cho, Juno; Ballouz, Dena; Azzouz, Lyna; Saleh, Sahal; Woodward, Maria A.

PURPOSE: : To assess the initial utilization, safety, and patient experience with tele-ophthalmology during the COVID-19 pandemic. DESIGN: : Cross-sectional study. METHODS: : We conducted a telephone survey and interview of a random sample of patients who received different modalities of care (in-person, telephone, videocall, or visits deferred) during Michigan's shelter-in-place order beginning March 23(rd), 2020. The survey assessed patient safety, patient satisfaction with care, perceptions of telehealth-based eye care, and worry about eyesight. Data was analyzed via frequency measures (e.g., means and standard deviations), Chi-square tests, ANOVA, and paired t-tests. Interviews were analyzed using Grounded Theory. RESULTS: : 3274 patients were called and 1720 (53%) agreed to participate. In-person participants were significantly older than telephone (p=0.002) and videocall visit (p=0.001) participants. Significantly more white participants had in-person visits than minority participants (p=0.002). In-person visit participants worried about their eyesight more (2.7, SD=1.2) than those who had telephone (2.5, SD 1.3), videocall (2.4, SD=1.1), or deferred visits (2.4, SD=1.2) (p=0.004). Of all telephone or videocall visits, 1.5% (n=26) resulted in an in-person visit within 1 day, 2.9% (n=48) within 2-7 days, and 2.4% (n=40) within 8-14 days after the virtual visit demonstrating appropriate triage to telemedicine-based care. Patients frequently cited a desire for augmenting the telephone or videocall visits with objective test data. CONCLUSIONS: : When appropriately triaged, tele-ophthalmology appears to be a safe way to reduce the volume of in-person visits to promote social distancing in the clinic. A hybrid model of eye care combining ancillary testing with a video or phone visit represents a promising model of care.