Your eye doctor will virtually see you now: synchronous patient-to-provider virtual visits in pediatric tele-ophthalmology

Abstract

Community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) in the United States on February 26, 2020, and the rapid spread that followed forced patients, providers, payors, and policy makers to adapt to an unprecedented, nearly instant, and enormous demand for virtual care. Although few US ophthalmology practices incorporated telemedicine prior to COVID-19, its use has now become the norm. Regarding the use of synchronous patient-to-provider virtual visits (SPPVV) in pediatric ophthalmology, we have pooled our collective experience at three academic practices across the country to describe initial workflows, technology solutions, use cases, and barriers to care.

Fig 1

Synchronous provider-to-patient workflow diagram. Rep, clinic representative; Tech, ophthalmic technician.

Fig 2

Screen-capture images from synchronous patient-to-provider virtual visits illustrating the findings associated with various virtual examination techniques. A, A 10-month-old child with right anophthalmia being treated with a hydrogel expander. Eyelid positioning and orbital expansion can be estimated through observation. B, A 23-month-old child with a left abducens nerve palsy demonstrated by a gentle doll's head maneuver performed by his mother. C, A 5-year-old child 3 months after botulinum toxin injection for an acute abducens nerve palsy caused by an ependymoma. Light reflex evaluation and parental cross cover testing showed no misalignment in primary gaze. D, An 11-year-old boy elevates his eyelid during evaluation of the superior limbus for a flare of vernal keratoconjunctivitis. E, A 16-year-old, developmentally delayed young man with tearing 3 weeks after cataract surgery. Oblique viewing and illumination highlight the anterior chamber, which appears free of hypopyon or significant fibrinous debris. There is also a lack of perilimbal injection. F, A 9-month-old girl with a congenital cataract showing maintained central red reflex with flash photography, indicating no significant progression of the lens opacity located inferior temporally (arrow) in comparison to the last office visit evaluation. G, A 16-year-old young woman with eczema diagnosed with a central cataract in the setting of subacutely diminished vision.