Telemedicine in Oculoplastics: The Real-Life Application of Video Consultation Clinics

Abstract

Purpose: Our oculoplastic service piloted a new video consultation (VC) clinic in response to the COVID-19 pandemic. Data were collected to determine whether specific patients are better suited to VC, and to quantify the true benefit of VC in patients that successfully attended. Methods: Data were collected prospectively on predetermined data collection forms, including consultation duration, diagnosis, management plan, and issues that arose. Results: 37.8% of new referrals and 60.9% of return patients were vetted as suitable for VC. Of those invited to attend, 83.4% agreed to a VC appointment. Of the patients appointed to a VC clinic, 71.7% (new)/75% (return) successfully completed VC, 14.9%/15.8% attempted a VC which ultimately failed, and 13.4%/9.2% did not attend. VC successfully prevented face-to-face consultation in 81.3% of new cases and 91.1% of returns. Ectropion, entropion and dermatochalasis (new referrals), and postoperative follow-up (return patients) were well suited to VC, while patients with “watery eye” (new), and lid or conjunctival lesions (return), often required face-to-face consultation. Problems (most common issues with patients connecting to the consultation, video quality, and audio quality) were encountered during 50.3% of calls, although 82.6% of attempted calls were ultimately successful. Age was not associated with the proportion of calls that were successful. Conclusions: VC is a useful tool for oculoplastic patients, irrespective of age, as long as the patient’s notes/referrals are carefully vetted to determine suitability. Patients with ectropion, entropion and dermatochalasis, and postoperative reviews are better suited to VC than those with “watery eye,” lid lesions, and conjunctival lesions.

Telemedicine Use by Oculoplastic Surgeons During the COVID-19 Pandemic

“…Our findings were largely consistent with the limited literature on telemedicine use for oculoplastic surgery that has mostly focused on settings outside the United States and singleinstitution reports. [6][7][8][9]11 A descriptive, international survey including a smaller number of oculoplastic surgeons reported similarly high rates of telemedicine use (71%, n = 50) during the COVID-19 pandemic, as well as a similar proportion reporting that they expected to use telemedicine more postpandemic (57%, n = 40). Our study adds important additional information regarding the frequency of telemedicine use relative to oculoplastic surgeons' practice characteristics and data on the categories of visit type, as well as specific clinical indications evaluated.…”

“…Consistent with other recent reports from single institutions, oculoplastic surgeons in our study reported providing a broad range of telemedicine care during the COVID-19 pandemic, including for new and returning patients, post-and preoperative evaluations, as well as both functional and cosmetic consultations. [6][7][8] One British study suggested that eyelid lesions were among the least well suited for evaluation using telemedicine. However, the majority of our respondents did report using telemedicine to evaluate eyelid lesions (68%).…”

“…4,5 The majority of studies consist of single-institution descriptions of telemedicine use by oculoplastic surgeons during the COVID-19 pandemic. [6][7][8] A recent international survey of 70 oculoplastic surgeons from 8 countries reported on telemedicine use, perceived utility, and perceived safety. 9 However, the study did not assess for relationships between the frequency of telemedicine use relative to oculoplastic surgeons' practice characteristics, nor did it include detailed descriptions of visit types, conditions evaluated, or barriers to implementation.…”

Automated extraction of clinical measures from videos of oculofacial disorders using machine learning: feasibility, validity and reliability

“…using a smartphone or webcam). Indeed, it is estimated that almost 40% of new oculoplastic patient encounters and 60% of follow up appointments might be suitable for remote video consultation [ 4 ]. Conducted during the height of the pandemic’s first wave, nationwide surveys of oculoplastic surgeons in the UK and the USA demonstrated that 86.6–88.8% of respondents were incorporating telemedicine into their routine clinical practice [ 5 , 6 ].…”

Video consultations in oculoplastic service: a continuing role post-pandemic?

“…The feedback was encouraging. Increasing age did not appear to be a factor in successful Oculoplastic VCs from a study of 187 patients [ 4 ]. Our experience reflected this; the ubiquity of devices supporting this platform possibly contributes.…”