Do you remember the COVID-19 pandemic? For some of us, it feels as if it was a lifetime ago.
Most countries around the world have emerged from the worst of the crisis despite some idiosyncrasies, for example, most airlines worldwide still demand that their passengers continue to wear facemasks. Now it’s almost impossible to imagine how we all lived under lockdown mandates for two years.
So much about the optometry industry was changed by the pandemic from patient management practices, to the treatments and techniques that optometrists could offer, and one of the most profound changes was the rise of telehealth.
Commonly referred to as telemedicine, telehealth was the topic de rigueur during the first year of the COVID-19 pandemic and it was hard to go through a health-focused magazine without reading one or two articles on the subject. Media MICE was no exception, we covered the latest developments in telehealth technology with considerable alacrity, as one might expect given that we were all keen to find new tools that could help alleviate the lack of treatment patients at that time.
At times, telehealth seemed like it could even be a panacea, something that could allow doctors and clinicians to get back into practice.
The Types of Telehealth
Nearly three years on from when the COVID-19 endemic began and all the changes the coronavirus caused in our lives, how much has telehealth altered optometry? We can say with a reasonable degree of certainty that telehealth has become an accepted and normal aspect of clinical practice today, but to what degree, and how practical has it been for optometrists?
What kind of telehealth techniques, tools, etc, have become popular amongst optometrists, and what lessons can be gleaned from all of this?
These are some of the questions considered in The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review, a comprehensive examination of how telehealth has been applied in optometry since the beginning of the COVID-19 pandemic. It represents one of the first systematic literature reviews on the subject and examined the databases of MEDLINE, Global Health, and Web of Science to discover the involvement of optometrists in the delivery of telehealth, described as teleoptometry in the study. The subsequent findings were reported according to the mode of telehealth used to deliver eye care, telehealth collaboration type, and the format and geographical areas where eye care via telehealth is being delivered.
Examining the efficacy of telehealth in optometry is important as, as the researchers behind the study point out, the impact of the COVID-19 pandemic ‘disproportionately affected vulnerable populations such as those living in remote areas, elderly people, socially disadvantaged people, children, and people living with disabilities, to access optometric care.’
The inability of these groups to properly access treatment increased inequality in accessing ocular health services. Telehealth, it was hoped, would increase access to health care by reducing barriers to treatment, including reduced travel time and cost. Was it able to do so?
Asynchronous Versus Synchronous
Twenty-seven studies from countries ranging from Spain to Pakistan and Ethiopia were included, and 11 of these studies included the role of optometrists as a member of the telehealth team providing eye care services. The most common form of teleoptometry delivery was via teleophthalmology, ie, closely liaising with ophthalmologists to diagnose patients, often involving conditions like diabetic retinopathy.
Specifically, this was asynchronous telehealth, where the optometrist collected clinical data from the patient in an in-person consultation that usually accompanied a referral to a teleophthalmology service. The second most common was synchronous telehealth, where optometrists used video consultations to deliver primary care, including low-vision rehabilitation, and then consulted with general and subspecialty ophthalmologists to improve the efficiency of the referral process. This would usually also involve comprehensive eye examinations with the assistance of an in-person technician.
The researchers found that optometric telehealth usually involved close collaboration with their counterparts in ophthalmology, and the most common form of collaboration was the delivery of eye care via teleophthalmology. This was followed by cases where the optometrist facilitated referral, communication, and management plans between the patient and the ophthalmologist. Single collaboration events were also reported including, for example, the sharing of retinal photos for interpretation by hospital technicians.
They concluded that based on their findings, the suitability of teleoptometry as an adjunct to face-to-face optometric care using telehealth is feasible and that literature demonstrates teleoptometry to be highly acceptable to patients and practitioners. Interestingly enough, they found that there was evidence to suggest that elderly patients, normally the most tech-averse, were the most in favor of continued telehealth services. It was also found that optometric telehealth provides real, actionable benefits to patients living in rural areas, those afflicted with disabilities, and low-income patients who would ordinarily struggle to access treatment.
However, as the researchers point out, there is a scarcity of evidence regarding the clinical benefits, safety, and outcomes of optometry-facilitated teleoptometry. Their study thus represents a solid launching board for further investigation of the efficacy of telehealth in optometry, and how it can benefit patients and clinicians alike. Let’s just hope that we don’t have to rely on another pandemic again to drive forward the development of new technologies as rapidly as telehealth.
- Massie J, Block SS, Morjaria P. The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review. Telemed J E Health. 2022;28(12):1753-1763.