Survey of Telehealth Adoption by Neuro-ophthalmologists During the COVID-19 Pandemic: Benefits, Barriers, and Utility

Abstract

Background: During the COVID-19 pandemic, telehealth modalities have come to prominence as a strategy for providing patient care when in-person care provision opportunities are limited. The degree of adoption by neuro-ophthalmologists has not been quantified.

Methods: Telehealth utilization pre-COVID-19 and peri-COVID-19 was surveyed among practicing neuro-ophthalmologists in and outside the United States using an online platform. Demographics, perceived benefits, barriers, and utility for different neuro-ophthalmic conditions were collected. Data collection occurred over a 2-week period in May 2020.

Results: Two hundred eight practicing neuro-ophthalmologists (81.3% United States, 50.2% females, age range <35 to >65, mode 35-44 years) participated in the survey. Utilization of all telehealth modalities increased from pre-COVID to peri-COVID (video visit 3.9%-68.3%, P < 0.0005, remote interpretation of testing 26.7%-32.2%, P = 0.09, online second opinion 7.9%-15.3%, P = 0.001, and interprofessional e-consult 4.4%-18.7%, P < 0.0005, McNemar). The majority selected access, continuity, and patient efficiency of care as benefits and data quality as a barrier. Telehealth was felt to be most helpful for conditions relying on history, external examination, and previously collected ancillary testing and not helpful for conditions requiring funduscopic examination.

Conclusions: Telehealth modality usage by neuro-ophthalmologists increased during the COVID-19 pandemic. Identified benefits have relevance both during and beyond COVID-19. Further work is needed to address barriers in their current and future states to maintain these modalities as viable care delivery options.

FIG. 1.

Geographic distribution of survey participants: Shade of world map (upper) and US map (lower) corresponds to the number of participants from each country (upper) and US state (lower).

FIG. 2.

Changes in neuro-ophthalmologist telehealth service utilization during the COVID-19 compared with immediately prior. Each pie represents self-reported status of survey participants with regard to utilization of telehealth modalities in their clinical practice peri-COVID according to pre-COVID utilization of different telehealth modalities (Box 1 for definitions): Video visits (A), remote interpretation of ancillary testing (B), online second opinion (C), and E-consult (D).

FIG. 3.

Benefits of video telehealth selected by neuro-ophthalmologists who are users of video visits during COVID-19: Each bar is the proportion of peri-COVID video users (n = 141) who selected that item as a benefit to video telehealth. Benefits are ordered by the proportion of peri-COVID video users selecting it.

FIG. 4.

Barriers to video telehealth selected by neuro-ophthalmologists according to video telehealth user status during COVID-19: Each bar is the proportion of peri-COVID video users (black, n = 141) or nonusers (gray, n = 66) who selected that item as a barrier to video telehealth. Patient technology barrier was not included in the survey choices but was added to the analysis based on inclusion in comments by multiple participants. Barriers are ordered by the proportion of peri-COVID video users selecting it.

FIG. 5.

Perception of video telehealth utility in select neuro-ophthalmic conditions: Each stacked bar represents a condition, with colors representing proportion who gave a response for that condition (n = 120–125), selecting that video telehealth is helpful (black), somewhat helpful (dark gray), or not helpful (light gray). Conditions are ordered by the proportion selecting “helpful.” AAION, arteritic anterior ischemic optic neuropathy; IIH, idiopathic intracranial hypertension; NAION, nonarteritic anterior ischemic optic neuropathy; OCT, optical coherence tomography; PTC, pseudotumor cerebri; VF, visual field.