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52 | EYEWORLD DAILY NEWS | MAY 16, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING continued on page 56 Bringing telemedicine into practice prescription refills taken care of from the comfort of their homes." Williamson Eye is using Doxy.me, which Dr. Williamson chose because he found it to be the simplest platform. "We like that Doxy is web-based, which means it doesn't require the patient to download an app. In- stead we can simply text them a link to my waiting room vs. spending time teaching them how to find the App Store. We also like that it's device agnos- tic, Apple and Android are both supported, and it allows us to invite multiple patients at once into a virtual waiting room," he said. "This way patients can wait for us to bring them from the virtual waiting room to the exam vs. my team spending time trying to call each patient and invite them in the waiting room one by one, which is inefficient. We can take ante- rior segment photos with it, and all of our providers have been able to take to it easily." So far, they've even caught a COVID-19 patient who present- ed with conjunctivitis. "A lot of physicians won- der, if you can't do a slit lamp exam or check pressure, is it worth it?" Dr. Williamson said. "The answer is yes. It doesn't replace an in-person exam, but when you are practicing what we call 'wartime ophthalmol- ogy,' anything is better than nothing. We think checking on patients to make sure their family is safe and not in need of medical attention or eyecare is important. Refilling medical prescriptions is of great value as well. If nothing else, just reaching out to your patients and making sure they know you're thinking about them and are still open for emergencies is important. Often we are the "telemedicine" program chal- lenging, he said. Dr. Baartman described a "hybrid program," where necessary testing is done in person but follow-up with the doctor is conducted afterward by phone or video. They've also implemented a system so all new patients can elect to be seen by a doctor virtually. "In creating this hybrid program, we want to implement some- thing that can be sustainable," Dr. Baartman said. "We do not know for how long we will need to be instituting some of these changes, so we think it's important to create something that is functional and not oner- ous to staff or doctors." Blake Williamson, MD Williamson Eye Center Baton Rouge, Louisiana In response to COVID, Dr. Williamson quickly trans- formed his practice into a virtual eyecare center with 10 of the 14 doctors at Wil- liamson Eye participating in telemedicine. From day 1 his goal was to make this a robust, patient-friendly experience that still allowed the doctors to take care of a relatively high vol- ume of patients. By the second week, they were approaching around 100 telemedicine con- sults per day. "At first, we had some issues with patient acceptance as many were intimidated by the technology," Dr. William- son said. "Our call center also struggled somewhat with how to explain the benefits of tele- medicine to patients. But with careful scripting of our teams working the phones, we were able to overcome this, and our patients have really enjoyed the opportunity to get their general eyecare needs and the best telemedicine program possible. The practice now has a "robust telemedicine program," seeing patients in the office for testing only; a doctor follows up later via a video or phone call. For glaucoma patients, Dr. Ristvedt said there may be a possibility for virtual visual field tests or IOP checks. Sim- ilarly, plastics patients could potentially do a virtual visual field test. While photographs can be taken and analyzed with telemedicine, Dr. Ristvedt said, one hurdle is pressure monitoring. There are technol- ogies available for remote IOP monitoring, but they haven't been implemented across the nation. Telemedicine services are keeping the practice moving during the pandemic, but Dr. Ristvedt added that there is some concern about volume when practices reopen as well, and these methods may still be useful then. Dr. Ristvedt said that patients being seen in the office are those who require a slit lamp exam or retina eval- uation. These could include patients who recently had glau- coma surgery or those who are experiencing flashes or floaters after cataract surgery. Dr. Baartman said that he's still seeing patients scheduled for essential postoperative care (like glaucoma surgical pa- tients or corneal transplants) as well as ongoing, sight-threaten- ing issues like corneal ulcers. One of the goals moving forward is to limit not only the number of in-person visits but also the amount of time each patient spends in the office. A lot is dependent on in-per- son diagnostics and slit lamp examination, making a true by Ellen Stodola Editorial Co-Director This article originally ran in the May issue of EyeWorld and high- lights experiences implementing telemedicine into practice from surgeons around the country. During the ASCRS Virtual An- nual Meeting, Ranya Habash, MD, will lead an instruction course on "Updated: Implement- ing Tele-Ophthalmology During the COVID-19 Pandemic." The course will be streamed from 1:00–2:30 p.m. ET on Sunday, May 17. Dr. Habash previously presented a webinar on the topic and will present information on the expansion of telehealth during the public health emer- gency, including information on insurance coverage. T elemedicine in practices has grown exponen- tially in light of the COVID-19 pandemic. EyeWorld spoke with ophthal- mologists around the country about their implementation of telemedicine and how it's allowing them to help patients while clinic and surgical ser- vices are limited. Deborah Ristvedt, DO Vance Thompson Vision Alexandria, Minnesota Brandon Baartman, MD Vance Thompson Vision Omaha, Nebraska Having not previously used telemedicine, Dr. Ristvedt said that Vance Thompson Vision began diving into best practices in mid-March, learning how to make it work for their patients, especially for the elderly pa- tient population. Doctors at the practice strategized and broke into teams, each addressing different issues, with Dr. Rist- vedt focusing on how to make

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