Utility of teleconsultation in accessing eye care in a developing country during COVID-19 pandemic

Abstract

Objective To evaluate the utility of teleconsultation in the provision of eye care services during the COVID-19 lockdown. Disparities in the consultation burden of sub-specialities and socio-demographic differences in teleconsultation utilization were also assessed. Methods Al-Shifa Trust Eye Hospital Rawalpindi began audio and video teleconsultation using broadband telecommunication services during the lockdown. Patients’ and consultations’ data gathered during the first three weeks after the commencement of this programme were compared with data from the four weeks prior to lockdown. The weekly consultation ratio and overall consultation burden of sub-specialities were measured. Chi-Square tests of association determined the relationship between different variables (socioeconomic status and consultation characteristics) and consultation modality (on-site vs online). Results In total, 17507 on-site consultations (4377/week) were conducted compared to 1431 teleconsultations (477/week), which maintained 10.89% of the weekly pre-lockdown eye care services. The post-lockdown teleconsultation programme saw a relatively higher percentage of service utility among female (47.09% vs 44.71%), younger-age (31.33±19.45 vs 41.25±23.32 years) and higher-socioeconomic-status (32.21% vs 0.30%) patients compared to pre-lockdown on-site consultations. The most common indication for teleconsultation was red-eye (16.70%). While cornea and glaucoma clinics maintained most of the pre-lockdown services (30.42% and 29% respectively), the highest dropout was seen in optometric and vitreoretinal services supporting only 5.54% and 8.28% of pre-lockdown services, respectively. Conclusion Digital initiatives could partially maintain eye care services during the lockdown. Focused strategies to improve teleconsultation utilization are required during the pandemic and beyond.

Trick or treat: Social Media’s dissemination power of ophthalmologic information in the pandemic context

“…As a practice to patient care orientation, teleophthalmology has successfully been used in the treatment and monitoring of a vast palette of ophthalmological diseases such as suspected glaucoma [ 14 ], cataract screening [ 15 ], diabetic retinopathy, age-related macular degeneration and retinopathy of prematurity, anterior segment imaging, telementoring and low vision consultation [ 3 ] and, in addition, it effectively reduced the number of unnecessary referrals to eye care organizations [ 16 ]. Further, teleophthalmology can successfully help in assisting more complex surgical procedures via telementoring, which can play an important role in maintaining qualitative standards of medical care under pressure circumstances [ 17 ].…”

“…According to Mansoor et al [ 3 ], the most frequently requested service for teleophthalmology during lockdown was red-eye (16.70%), which was associated with seasonal ocular allergic disorders, followed by trauma (9.36%) and infectious keratitis-related consultations (4.33%). Similarly, while glaucoma is a chronic disease, and most patients require a lifelong therapy for its treatment, its care may be improved by finding and seeking information regarding the disease and treatment options, emotional support and sharing experiences [ 27 ], especially some advice regarding drug allergies or ocular surface problems [ 3 ].…”

“…According to Mansoor et al [ 3 ], the most frequently requested service for teleophthalmology during lockdown was red-eye (16.70%), which was associated with seasonal ocular allergic disorders, followed by trauma (9.36%) and infectious keratitis-related consultations (4.33%). Similarly, while glaucoma is a chronic disease, and most patients require a lifelong therapy for its treatment, its care may be improved by finding and seeking information regarding the disease and treatment options, emotional support and sharing experiences [ 27 ], especially some advice regarding drug allergies or ocular surface problems [ 3 ]. Another study [ 18 ] investigated patient satisfaction with the Virtual Consultations that were used in the Ophthalmology practice during the COVID-19 pandemic and revealed that 95% of patients rated their overall experience with the virtual consultation as good and very good, and that all study participants will recommend the virtual consultation approach to others.…”

“…Another study [ 18 ] investigated patient satisfaction with the Virtual Consultations that were used in the Ophthalmology practice during the COVID-19 pandemic and revealed that 95% of patients rated their overall experience with the virtual consultation as good and very good, and that all study participants will recommend the virtual consultation approach to others. However, middle-aged, and elderly patients with cataract, presbyopia, and stable posterior segment pathologies, namely, stable diabetic retinopathy and stable age-related macular degeneration, were more likely to wait for the face-to-face ophthalmology services rather than be evaluated through a teleconsultation [ 3 ].…”

“…Along with the development of several digital technologies that address clinical diagnoses and treatments for different diseases, the pandemic context was the harbinger of an emergent phase in medicine, shaped by the increased usage of telemedicine and teleconsultations, gaining more popularity in the COVID-19 era [ 3 ]. Telemedicine relies on the telecommunication technology and provides remote medical assistance by telephone, internet, or other networks [ 4 ].…”