This column over the last couple of weeks has covered topics on eyecare and contact lens related topics in COVID-19 times. Sometimes the link between the two was subtle, in others it was quite directly related. This topic is 100% ‘on-topic’. I never seriously considered telemedicine to be honest, until now.
Granted, the US is way ahead of Europe in this regard. Typically, distances are much smaller here. I was following a live webinar recently by the Scleral Lens Education Society – an excellent resource for everything you need to know about scleral lenses by the way. John Gelles from the CLEI Center for Keratoconus in Teaneck New Jersey, Marcus Noyes from the University of IOWA and Clarke Newman from Plaza Vision Center in Dallas, Texas hosted a fantastic, clinically relevant and to-the-point panel discussion on the topic. To illustrate the point above: Marcus mentioned that some of their patients ‘called in’ because they had a six-hour drive ahead of them, to come to their clinic. Six-hour drive? From Amsterdam, if you drive six hours you are not only in a different country: you are in the next country after that.
So, the need and urge for telemedicine surely is related to ‘distance’. But now we all have to deal with it, as we in a way have to ‘triage’ our patients via phone to see if there is indeed a need to come in. Here modern technology comes to the rescue. But only if you do it right. Most smartphones produced after let’s say 2014 have the ability to create good images, to help and guide us through that decision-making tree. First thing that not everybody realises is: the cameras on the back of the phone are the best ones (compared to the ones on the front). So, if you take a picture of your own eye, maybe do it in front of the mirror and do not use the ‘selfie-mode’ where the screen is facing you. Flash should be turned-on (not on automatic) and there needs to be a reliable distance from the eye to get a sharp image (differs per smartphone). Enough pixels are crucial to have the option for digital zoom. Most modern smartphones provide that these days.
Of course, it’s not perfect. Especially in patients with more pigmented irises, the cornea is often harder to image. We also have no binocularity, and only ‘diffuse illumination’ if we convert it to slit lamp terminology. A flashlight can sometimes help to trans-illuminate the cornea, in case of corneal ulcer for instance. And we don’t have fluorescein to image the cornea. Good thing is though, if you have a live stream with the patients, you can see/judge just in how much pain he/she is (are they in a dark room?). The panellists agreed that telemedicine is designed to do on established patients, where we have all their info on-file. Crucial too (still) is the history taking. It may revert us back to school, and we may have to polish up our ‘anamneses-skills’ – as that appears to be crucial when doing telemedicine. Will telemedicine tell you the diagnosis? It can certainly help in making the right decisions. Let’s take the example of a subconjunctival haemorrhage. It looks awful, patients are in panic. But we know it is benign. No need to come in. So yes, it can help. Be prepaRED.
This Eef@online series is kindly supported by an educational grant from Contamac
“It looks awful, patients are in panic. But we know it is benign. No need to come in.”
“From Amsterdam if you drive six hours you are not only in a different country: you are in the next country after that.”
In the series Eef@online