Telemedicine use skyrocketed when COVID-19 lockdowns precluded in-person visits, then persisted for some time for those patients not comfortable venturing to doctor offices even when lockdowns were lifted. Many doctors and patients alike had appointments via phone or video call for the first time over the past year.

In a recent cross-sectional study, authors assessed the initial utilization, safety and patient experience with telemedicine during the pandemic.

A telephone survey and interview of a random sample of 1,720 patients who received different modalities of care (in-person, telephone, video call or visits deferred) during Michigan’s shelter-in-place order beginning March 23, 2020 was conducted.

In-person participants were significantly older than telephone and video call visit participants and more white participants had in-person visits than minority participants. In-person visit participants worried about their eyesight more than those who had telephone, video call or deferred visits.

Of all telephone or video call visits, 1.5% resulted in an in-person visit within one day, 2.9% within two to seven days and 2.4% within eight to 14 days after the virtual visit, demonstrating appropriate triage to telemedicine-based care. Patients frequently cited a desire for augmenting the telephone or video call visits with objective test data.

Because visualizing the anterior segment of the eye on a video visit was more feasible than examining the posterior segment, some specialties were able to use telemedicine at higher rates than others.

“For example, cornea specialists had the highest volume of telemedicine visits in this sample while retina specialists had the lowest,” the authors explained. “Cornea specialists triaged phone calls for their own clinics in March and April to minimize in-person visits and were more comfortable conducting visits via videocall or telephone call as they could still visualize the anterior segment if needed by photo or videocall.

“Second, our center implemented a drive-through intraocular pressure (IOP) check with iCare tonometry and the results were followed up via a virtual visit at a different time. This hybrid model of in-person ancillary testing followed by a virtual visit likely accounts for the increase in virtual care utilization by glaucoma providers and patients.”

The study concludes that telemedicine appears to be a safe way to reduce the volume of in-person visits to promote social distancing, and a hybrid model of eye care combining ancillary testing with a video or phone visit represents a promising model of care.

“Our mixed-methods approach to understanding our patients’ experience with their care during the pandemic led us to hypothesize that a hybrid model of care combining in-person testing followed by a virtual physician consultation may improve efficiency, maintain safe distancing and increase patient satisfaction,” the authors concluded in their study. “However, based on how satisfied our participants were with their experiences with [telemedicine], we suspect that virtual care will continue to be an important part of how eye care is delivered, even after the COVID-19 pandemic.”

Newman-Casey PA, De Lott L, Cho J, et al. Telehealth-based eye care during the COVID-19 pandemic: utilization, safety and the patient experience. American Journal of Ophthalmology 2021. Epub ahead of print.