Eyeworld Daily News

32 | EYEWORLD DAILY NEWS | MAY 6, 2023 ASCRS ANNUAL MEETING DAILY NEWS D igital Day, sponsored by the Digital Ophthalmic Society (DOS), took place alongside the ASCRS Subspecialty Day programs and included sessions that looked at the impact of digitiza- tion, artificial intelligence, and the metaverse. One of these sessions was telemedicine in ophthalmology. Jade Moon, MD, shared first- of-its-kind analysis that reported on in-person revisits after an ophthal- mic telemedicine visit. This was a single-center, retrospective study that had 2,262 telemedicine encoun- ters (1,911 patients) in 2020 and 147,211 initial in-person encounters (65,763 patients). There were 147 in-person revisits (140 patients) within 7 days of the telemedicine encounter for a rate of 7.3%. The reason for the initial tele- medicine visits among the group that later had in-person revisits were acute care (36.7%), long-term management (60.5%), and new patient (2.7%). Most revisits were recommended during the initial telemedicine appointment with only 0.6% of revisits occurring without a provider recommendation. This, Dr. Moon said, suggests that the physi- cian made appropriate care decisions and recommendations during the televisit. There were higher odds of having a revisit after a telemedicine encounter if the visit was for glau- coma or if the encounter was with an optometrist. Dr. Moon speculat- ed that an on-call hotline (which counted as a televisit) was often staffed by ODs, and the nature of those calls might have had a higher rate of recommending an in-person visit. There were significantly lower odds for patients who lived more than 50 miles away. There was no significant difference in revisits after an audio-only or video televisit, Dr. Moon said. Later in the session, Grayson Armstrong, MD, described hybrid ophthalmic telemedicine. This model involves the patient getting high-quality ophthalmic testing and examination at a center with a technician close to their home. The physician reviews testing asynchro- nously at a different time. Then the patient and physician have a tele- medicine visit to discuss the testing and care going forward. He said hybrid ophthalmic telemedicine could increase access to care, improve patient satisfaction, decrease disparities, and reduce healthcare costs. The types of pa- tients who could benefit from this model include glaucoma suspects, Plaquenil screening, keratoconus, dry eye screening, and postop patients. Dr. Armstrong also said that this model can help as there continues to be an increase in the aging popula- tion and ophthalmic diseases and, in some areas, a low ophthalmolo- gist-to-patient ratio. Another presentation looked at a controlled drone slit lamp. Pozzo Giuffrida, MD, said this project start- ed in 2010 when the Department of Defense asked the Ophthalmic Bio- physics Center to create a slit lamp that could be shipped via drone from one military site to another so doc- tors could remotely triage soldiers with ocular injuries. Now, with a third-generation device, Dr. Giuffrida showed how the slit lamp can be controlled by a doctor anywhere in the world as long as they have an internet connection, communication software to speak to the patient, and an electronic device with a keyboard (laptop, desktop, tablet). The technology allows the physician to see the patient's head placement as well as all the func- tionality of an in-person operated slit lamp. In addition to being used by the military, this remotely controlled slit lamp has been used to bring eyecare to underserved areas of the world and during the pandemic. Another device-based tech- nique—GoPro Operations Live on Facebook (GOLF)—was described by Vellam Vivekanandan, MD. This form of live-streaming a surgery for teaching, telementoring, and other learning opportunities was devel- oped during the pandemic when Dr. Vivekanandan said the number of people in the operating room was limited. Creating a system that attached a GoPro to the microscope and live-streaming it on a private Facebook page allowed residents who couldn't be there in person to view surgery. Dr. Vivekanandan said the hospital system has continued to use this system to monitor residents while they're performing surgery and as a teaching tool. He said that mentors and teachers can watch the live-stream and in real time provide comments to help guide the surgery (an assistant reads the comments to the operating surgeon). There were a few other presenta- tions in the session. One described a telemedicine curriculum and another the use of telemedicine for diabetic retinopathy screening. Editors' note: Dr. Armstrong has finan- cial interests with several ophthalmic companies. Dr. Giuffrida, Dr. Moon, and Dr. Vivekanandan do not have financial interests related to their comments. Digital Day looks at teleophthalmology

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