Hybrid Ophthalmology Telemedicine Model May Serve as Alternative to Standard Care

Xuejing Chen, MD, MS

A hybrid ophthalmology telemedicine model may serve as an alternative for standard in-person visits according to new cross-sectional findings, with a particular emphasis on patients with glaucoma and retinal diseases.

Although there were visit adherence concerns as these patients were required to attend both imaging and virtual appointments, hybrid visits experienced better adherence than all eye clinic visits during the study period.

“This high rate of success coupled with the clinical capacity limitations and desire by both patients and clinicians to reduce physical time in clinic reinforces the utility of hybrid visits for a carefully selected patient population,” wrote study author Xuejing Chen, MD, MS, Department of Ophthalmology, Boston University School of Medicine.

The hybrid ophthalmology telemedicine model consisted of a combined in-person, non mydriatic imaging appointment with a trained technician followed by a virtual appointment with the clinician. Investigators noted the hybrid model combined limited objective data with the benefit of telemedicine.

But, a lack of data has led to questions on the ability of the concept to deliver quality patient care, particularly during the COVID-19 pandemic. Chen and colleagues reported on outcomes from a hybrid telemedicine model implemented on a wide scale in the Department of Ophthalmology at Boston Medical Center in 2020.

The participants for hybrid visits were selected either by the clinician through manual medical record review or direct scheduling following any visit type, according to the investigators. Selection was up the discretion of each clinician, but it was recommended to choose stable, nonprocedural, non-vision-threatening diseases that were able to be evaluated with a standard protocol-based set of imaging and testing.

Investigators defined 4 outcome measures by situation where management was beyond verbal counseling:

1. Need for subsequent procedure visit
2. Medication adjustment
3. Nonurger referral
4. Urgent referral

They additionally defined adverse outcomes as irreversible vision loss due to a hybrid visit missing a worsening disease process or a new diagnosis, as well as the need for further in-person evaluation to reach a management decision.

There were a total of 940 hybrid visits associated with 889 patients (506 female patients [56.9%]; mean age, 62.1 years) occurring from April to December 2020. Data show an overall hybrid no-show rate of 13.8% (n = 151 visits) which was lower than the 22.9% (monthly range, 18.55 - 31.3%) no-show rate for all ophthalmologic visits from April to December 2020.

The chief concern for the visits were primarily glaucoma (n = 424 visits [45.1%]) and retinal diseases (n = 499 visits [53.1%]). Clinicians recommended patients from 2.7% of hybrid visits (n = 25 visits) for a procedure visit, including anti-VEGF injection, anterior segment laser, or retinal laser.

Moreover, data show 2.3% of hybrid visits (n = 22 visits) led to a change in medication and clinicians referred patients from 4.7% of all visits (n = 44 visits) for nonurgent consultation with another subspeciality. There were no referrals to another subspecialty for consultation considered urgent.

From the total completed hybrid visits, 671 (71.3%) returned to the eye clinic within 1 year. A total of 16 patients (1.7%) required an additional standard in-person visit to reach a management decision. Investigators noted there were no instances of irreversible vision loss detected at the follow-up visits.

The study, “Outcomes of a Hybrid Ophthalmology Telemedicine Model for Outpatient Eye Care During COVID-19,” was published in JAMA Network Open.