NEW YORK — Eye health telemedicine has gained “exponential” speed during the COVID-19 pandemic, and the trend is unlikely to abate soon — even with the easing of government restrictions, according to Dan Neely, senior medical adviser at the vision nonprofit Orbis International.
Devex finds out how the new coronavirus is affecting vision and eye care services and explores opportunities for experts to provide support in the pandemic response.
“In the last two months, all of a sudden, everyone has been forced to do virtual visits for patient care. And I think there's going to be a paradigm shift in people's comfort level with this,” Neely said in a recent interview with Devex. “This is going to change what everyone does going forward.”
An estimated 2.5 billion people have a vision impairment requiring glasses that they cannot access and about 80% of these people live in just 20 low- and middle-income countries, according to the Overseas Development Institute. The gap in eye care impacts everything from education and road safety to employment prospects and personal mobility.
While there has been a recent rise in attention to the challenges of vision impairment and national programs to provide eye health care, international development funding for vision care remains low.
Orbis International, which operates sight-saving programs in 19 countries — including India, Ethiopia, and Bolivia — also hosts an open-access telemedicine platform called Cybersight. Some of Orbis’ nonemergency work, including its Flying Eye Hospital, has been halted during the global health crisis, but telemedicine consultations continue. Other global vision NGOs, such as The Fred Hollows Foundation, have similarly been looking to telemedicine as an alternative during the pandemic.
“The doctors we work with don't often have mentors. In the United States, about half of all ophthalmologists have gone on to train in a subspecialty area,” Neely said.
“In South Africa, maybe only 1% of ophthalmologists have done any kind of subspecialty fellowship training, and in many other countries, this number is lower. The gap we are filling is not really patient care; it's mentorship of the physicians,” he continued.
There has been a “significant spike in demand” for telemedicine consultation and remote learning over the last few months as the new coronavirus has continued to spread worldwide, according to Neely. Cybersight online course activity more than tripled from February to April, and the platform now has 25,000 users across 199 countries, he said.
“Our numbers have skyrocketed. So looking at new registered users — people using our service for the first time — in the month of February, we had just under 900 people sign up. In March, it was double that number and went up to 1,700,” Neely said. “And then in April, the rise was exponential, with 3,600 people.”
“You're seeing a new paradigm shift as we move towards remote teaching.”— Dan Neely, senior medical adviser, Orbis International
In Ecuador, access to vision care tends to drop off as people move further away from cities, according to Andrea Molinari, program director of a fellowship program in pediatric ophthalmology at Hospital Metropolitano in Quito. Molinari also serves as a volunteer faculty member with Orbis and has performed live surgeries from India to Peru.
Teleconsultations have increased “tremendously” in Ecuador during the pandemic, in part because doctors who are not providing emergency services and are out of the office have had more time to connect with one another, Molinari said. Molinari herself has also been conducting more online consultations over the last few months.
“The pandemic brought us to a stop. We are so busy in our normal lives that we do not always realize how many options we have on the internet for continuous medical education. With people out of their offices, we realize there is so much [opportunity for] education [that] people were not aware of before,” Molinari told Devex.
In practice, ophthalmologists can use Cybersight to share lessons with other doctors worldwide and receive advice on specialty treatments or surgeries. Neely described watching ophthalmologists in Peru perform a live surgery while he was in his home state of Indiana.
“We're having a conversation while they're doing the surgery. And I can ask questions. I can make comments or suggestions. And so you're seeing a new paradigm shift as we move towards remote teaching,” Neely said.
The sudden switch to Cybersight, in lieu of in-person training sessions, challenged common ideas of what doctor training and patient consultation should look like, he said.
“At first, we were all worried about trying to replicate what we do in the office during an exam. And I think we learned that you don't do the same kind of thing. The exam becomes secondary. The conversation is 90% of the information you get, and you can make a lot of decisions based on just that conversation,” Neely said.
Issues such as internet bandwidth have not significantly challenged the platform’s usage either. Many doctors rely on their phones and stronger mobile connections. Live surgeries will not happen when internet bandwidth is a problem.
The forced shift to vision telemedicine has been relatively seamless for many users, Neely said, showing the potential for the technology to continue to grow and expand ophthalmologists’ access to support and training.
“Whenever this health crisis is resolved, I don't think we are going back to our previous baseline level of activity,” Neely said. “I think we will have gained some usership that stays with us.”
But Molinari cautioned that while telemedicine can increase people’s access to vision care and connect more doctors virtually, it cannot replace in-person training sessions and consultations.
“It is not the same quality. If you are with a student next to you and you are teaching him or her how to do a procedure, it is different than seeing it on the internet. Our in-person work cannot be replaced by the material you can find on the internet,” Molinari said.
However, the program also offers new possibilities of inclusion for non-English speakers.
“For many of us, including me, English is not our mother tongue. For us, having the possibility to listen to a prerecorded lecture and then going back if you didn’t understand it is very valuable and this makes a difference,” Molinari said.
Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.