Telemedicine: Here to Stay?

In the January/February 2020 issue of Modern Optometry, Anthony DeWilde, OD, FAAO, wrote a thought-provoking article entitled “Telemedicine Is Increasing Patient Access to Eye Care.”¹ He analyzed telemedicine and its current role in eye care through an extremely wide lens. Little did Dr. DeWilde, or any of us, realize how telemedicine would be catapulted to the forefront of public consciousness just a few months later. By March, the COVID-19 pandemic had fundamentally altered every aspect of our lives, including the practice of medicine.

Since then, the concept of safe, timely, and, effective health care has become increasingly challenging as eye care practitioners look for any option to protect their own health and that of their staff and their patients. Telemedicine has played an important role in those efforts.

TELEHEALTH

As a refresher, the US Department of Health and Human Services (HHS) states that the definition of telehealth is much broader in scope than that of telemedicine. Telemedicine refers specifically to remote clinical services, whereas telehealth encompasses remote health care that does not always involve clinical services.² This includes videoconferencing, the sending and receiving of still images, patient portals, remote monitoring of vital signs, nursing call centers, etc.

Medicaid defines telemedicine as two-way, real time interactive communication between the patient and the physician or practitioner at a distant site.³

The American Telemedicine Association provides a more detailed definition: “Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patients’ health status.”⁴

TELEMEDICINE IN OPTOMETRY

How does telemedicine fit into the practice of eye care today, and what modes are being used? For years, telemedicine has been used in screening for diabetic retinopathy (DR) and for retinopathy of prematurity (ROP) in children. In DR and ROP screening, images are typically captured at a clinic and then graded digitally by an optometrist or ophthalmologist at a remote site.

This type of modality is commonly known as asynchronous, or store-and-forward, telemedicine. The American Optometric Association’s 2020 position statement defines telemedicine in optometry as “the provision of eye, adnexa, visual system, and related systemic health care services (collectively ‘eye, health, and vision services’). Asynchronous and synchronous technologies can be used to provide this type of care, including videoconferencing, internet-based services, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”⁵

Another modality, synchronous telemedicine, defined as “live 2-way interaction between a person (patient, caregiver, or clinician) and a clinician using audiovisual telecommunications technology,”⁶ experienced an explosion of growth during the nationwide lockdowns mandated to stop the spread of COVID-19. I believe optometry can pair well with this type of telemedicine.

During the lockdown, the US Centers for Disease Control and Prevention’s website strongly advocated the use of telemedicine in place of in-person clinical visits. This message was received loud and clear by the eye care profession. Before the pandemic, less than 25% of eye care patients were aware of telemedicine as an option. As the pandemic lingered, leading eye care telemedicine platforms reported incredible growth, ranging from 257% to 700% increases in virtual visits.⁷

These numbers do not include Apple FaceTime and similar video chat services that are not HIPAA-compliant. These services are nonetheless being used by some providers because HHS has stated that non-HIPAA compliant platforms can be used to accomplish audio and visual communication during coronavirus.⁸ If an eye care practice is looking to establish a foothold in telemedicine, however, I recommend that they do some research and begin by using a HIPAA-compliant program (see Telemedicine’s Primary Players in Optometry).

I practice in a multidisciplinary center in Louisiana, and I asked one of our ophthalmologists, Blake K. Williamson, MD, MPH, for his opinion on the role of telemedicine in our practice. “At the beginning of COVID, we found telemedicine to be our practice savior, as it was the only way we could see our patients due to government mandates,” he said. “But now we have found it to be a practice builder, as it has allowed us to greatly increase our LASIK volume due to the availability of virtual consults and [to increase] our clinic efficiency by offering virtual postoperative visits for refractive cataract surgery patients.”

FILLING A NEED

As we become increasingly reliant on imaging technology, telehealth options offer us the ability to review this information and consult with patients in a manner that is convenient for both parties. Although it can’t replace the in-person experience, telemedicine is helping many clinics, including ours, find new ways to offer eye care services to patients who prefer to stay home during the pandemic.

The growth of telemedicine in eye care is accelerating, as is apparent from the plethora of companies entering this area of optometry (see Telemedicine’s Primary Players in Optometry). Many of the biggest players in corporate eye care have made substantial investments in remote eye exam equipment and training. In some markets, patient demand exceeds doctor availability, and remote care can help provide a solution to this problem.

As technology continues to advance and patients become comfortable with the use of telemedicine, it appears that telehealth is here to stay. Many optometrists have adapted to include telemedicine in their practice patterns, and it’s up to each doctor to determine which area or areas of telemedicine to incorporate into his or her practice, if any.

As optometry practices have reopenened and schedules expanded, some have begun to rely less on telemedicine. Others, however, have noted that, by fine-tuning their telemedicine processes, they can resolve social distancing and scheduling issues, allowing their doctors to space out their schedules so that not all providers and staff are in the office at the same time.

It appears that a hybrid model of practice is emerging, in which testing is conducted in-person by a technician team and a virtual visit with the physician is later performed to discuss the results and any pertinent care plans. Regardless of how you feel about telemedicine, it’s important to at least be aware of its potential for the future. If you ignore it, you do so at your own peril.

• 1. DeWilde A. Telemedicine is increasing patient access to eye care. Modern Optometry. 2020;2(1):28-30.
• 2. What is telehealth? How is telehealth different from telemedicine? HealthIT.gov. October 17, 2019. www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine. Accessed February 3, 2021.
• 3. Telemedicine. Medicaid.gov. www.medicaid.gov/medicaid/benefits/telemedicine/index.html. Accessed February 2, 2021.
• 4. What is telemedicine, exactly? The American Telemedicine Association. www.americantelemed.org/about-telemedicine/what-is-telemedicine#.U-b7gIBdWt0. Accessed February 18, 2021.
• 5. Position statement regarding telemedicine in optometry. The American Optometric Association. October 2020. www.aoa.org/AOA/Documents/Advocacy/position%20statements/AOA_Policy_Telehealth.pdf. Accessed December 27, 2020.
• 6. Patient engagement. The Office of the National Coordinator for Health Information Technology. www.healthit.gov/topic/health-it-health-care-settings/telemedicine-and-telehealth. Accessed February 18, 2021.
• 7. Saleem SM, Pasquale LR, Sidoti PA, Tsai JC. Virtual ophthalmology: telemedicine in a COVID-19 era. Am J Ophthalmol. 2020;216:237-242.
• 8. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. US Department of Health & Human Services. bit.ly/MOD321ref8. Accessed February 2, 2021.