Tele-Neuro-Ophthalmology Utilization, Availability, and Attitudes: Update 1 Year Into the COVID-19 Public Health Emergency

Abstract

Background: Telehealth was rapidly adopted early in the COVID-19 pandemic as a way to provide medical care while reducing risk of SARS-CoV2 transmission. Since then, telehealth utilization has evolved differentially according to subspecialty. This study assessed changes in neuro-ophthalmology during the first year of the COVID-19 pandemic.

Methods: Telehealth utilization and opinions pre-COVID-19, early pandemic (spring 2020), and 1 year later (spring 2021) were surveyed among practicing neuro-ophthalmologists in and outside the United States using an online platform. Demographics, self-reported utilization, perceived benefits, barriers, and examination suitability were collected over a 2-week period in May 2021.

Results: A total of 135 practicing neuro-ophthalmologists (81.5% United States, 47.4% females, median age 45-54 years) completed the survey. The proportion of participants using video visits remained elevated during COVID + 1 year (50.8%) compared with pre-COVID (6%, P < 0.0005, McNemar), although decreased compared with early COVID (67%, P < 0.0005). Video visits were the most commonly used methodology. The proportion of participants using remote testing (42.2% vs 46.2%), virtual second opinions (14.5% vs 11.9%, P = 0.45), and eConsults (13.5% vs 16.2%, P = 0.38) remained similar between early and COVID + 1 year ( P = 0.25). The majority selected increased access to care, better continuity of care, and enhanced patient appointment efficiency as benefits, whereas reimbursement, liability, disruption of in-person clinic flow, limitations of video examinations, and patient technology use were barriers. Many participants deemed many neuro-ophthalmic examination elements unsuitable when collected during a live video session, although participants believed some examination components could be evaluated adequately through a review of ancillary testing or outside records.

Conclusions: One year into the COVID-19 pandemic, neuro-ophthalmologists maintained telemedicine utilization at rates higher than prepandemic levels. Tele-neuro-ophthalmology remains a valuable tool in augmenting patient care.

FIG. 1.

Distribution of practicing neuro-ophthalmologists' self-reported utilization of video visits before COVID, during early COVID, and 1 year into COVID. Each pie represents a period. Slice color indicates whether survey participants were using video visits during the period (black) or not (gray stratified by availability in their practice).

FIG. 2.

Utilization, availability, and provider desirability of telehealth modalities as reported by neuro-ophthalmologists in independent practice. For top 4 plots, each plot represents a distinct telemedicine modality. Each line shows the proportion of survey participants reporting utilization (solid), availability (dashed), and provider interest in (dotted) each telemedicine modality during each period. The bottom plot shows utilization only for 3 additional telemedicine modalities as reported by survey participants. Availability and provider interest were not surveyed for the modalities included on the bottom plot. Pre-COVID is before COVID-19 stay-at-home orders were enacted in each participant's place of practice (February 2020 in the United States). Early COVID is the month following stay-at-home orders in each participant's place of practice (March–April 2020 in the United States). One year COVID is 1 year after early COVID.

FIG. 3.

Perceived benefits and barriers to video telemedicine use selected by neuro-ophthalmologists in independent practice. Upper: Benefits reported by survey participants who offer video visits (n = 67) were asked to agree or disagree that each statement was a benefit. Lower: Barriers reported by survey participants (n = 119).

FIG. 4.

Practicing neuro-ophthalmologists’ opinions on suitability of data elements to support medical decision-making for care delivered through video visits, n = 116.