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Telehealth and Ophthalmology: Enhancing Accessibility and Equity in Vision Care

Telehealth and Ophthalmology: Enhancing Accessibility and Equity in Vision Care

Updated :
April 2, 2024
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Though telehealth has adapted to meet healthcare needs during the recent pandemic, it hasn't stopped growing from there. Telehealth providers have proved that it's possible to deliver accessible and affordable quality healthcare services. In fact, telehealth in the US is now most commonly used by senior citizens, individuals covered by Medicaid and Medicare, African Americans, and people who earn less than $25,000 annually1.

In these cases, however, telehealth is mostly used for primary and mental healthcare. That's where telehealth is currently evolving. Now, even specialties that may seem difficult to translate to virtual care use telehealth to enhance their services. Ophthalmology and optometry, which are concerned with eye health, are increasingly leveraging telehealth along with other technologies to provide accessibility and equity in vision care whether in the US or internationally. Here's how.

Telehealth minimizes travel to physical appointments

Where a patient lives is often a barrier to care: far-flung areas usually have less access to the ophthalmologists and eye care facilities needed to address vision issues. This problem usually requires patients to travel long distances to the nearest urban center for treatment, which they may choose not to do—especially if they experience mobility issues that affect their ability to travel. As a result, people in rural and low-income communities have a higher risk of developing vision problems.

With telehealth, these individuals now have the option to go to a nearby local clinic or community health center. Grassroots-level healthcare workers can conduct a single physical eye screening to facilitate triage and then refer the patient to an optometrist or ophthalmologist for a remote consultation. This minimizes the number of physical appointments a patient has to make and eliminates the need to travel just for initial testing. 

Enabling remote eye care models

This is the model VSee used during a medical mission trip to Iraq. It ran a remote eye clinic at the UNHCR refugee camp in Duhok using VSee’s mobile telemedicine kit. Without having to leave the camp, the refugees were able to receive a telemedicine consult with an ophthalmologist located in Argentina. In one case, the surgeon noticed a possible tumor in a little girl and referred the family to the local public Azadi Hospital for immediate treatment.

This model is also utilized at the Shimen Health Center in Taiwan. Elderly diabetes patients in the rural Shimen area of New Taipei City no longer need to make a long drive out to the nearest hospital for their retinopathy checkups. Instead, they can just walk to their local health clinic. Here, healthcare professionals use VSee’s remote telehealth cart solution to conduct and automatically upload retinal scans to EMRs, which ophthalmologists from other hospitals can then assess. That leads us to the next benefit of telehealth for improved vision care:

Telehealth facilitates coordinated services for improved outcomes

With telehealth, patients can get a diagnosis, receive a treatment plan, and procure what they need to follow it remotely. In line with the above, an initial physical eye test allows patients to get the rest of their assessments done online, regardless of whether the vision issues they're experiencing are mild or severe. That's because telehealth platforms can provide networks of primary and specialist medical professionals, allowing patients to be smoothly referred from one to the other. As proven by case studies in rural Western Australia, these telehealth-coordinated services can be especially effective for improving patient outcomes in eye health—especially if conducted between optometrists, who provide primary eye care, and ophthalmologists with more specialized eye care expertise. 

Enabling the continuum of care from online glasses to remote eye consults 

For example, once an optometrist receives an eye screening from a local clinic, they can assess it and call the patient to provide a prescription and recommend possible corrective aids. From here, patients can easily purchase eyeglasses online by uploading that prescription on a retailer's website. They can then use artificial reality-powered features to try on and select a pair of frames, resulting in the well-fitted, correct prescription glasses getting delivered straight to their doorstep. Aside from improving access for those who cannot physically visit an optometrist and shop for visual aids, this gives patients an easy way to immediately follow their optometrist's recommendations for improved vision outcomes. 

For more serious eye concerns, optometrists can then use telehealth networks to refer patients to ophthalmologists. Via teleconsult, these professionals can conduct more advanced eye examinations, prescribe medications, or ask that patients come in for further testing or treatments like surgery—meaning in-person appointments will only be necessary for the most urgent cases.

Telehealth can reduce eye care costs

More importantly, the convenience and connectivity that telehealth provides can lower the costs that usually deter patients from receiving specialist eye care. 

  1. Telehealth visits are cheaper or even free- A Medical Economics article refers to a 2017 study which found that the average telehealth visit was $79 versus $146 for an in-person visit. Patients may be able to utilize their health plan’s telehealth services without a copay or deductible. For example, one health plan has recently introduced a tele-therapy service called Sword for treating back and neck pain. This service is free to its members including the tablet equipment versus in-person physical therapy for which members would still be responsible for any copays and deductibles. 
  2. Telehealth can save patients money - A JAMA study of oncology patients found that their indirect cost savings from doing telehealth instead of in-person visits was a mean total of $141.10 to $222.80 per visit. (Indirect costs are primarily travel costs and lost productivity and time costs.) Also patients, particularly those with accessibility issues, are more likely to improve their health status with the increased access to healthcare providers, specialists, and other resources that virtual care brings. This can indirectly help lower their plan premiums and deductibles.

Public programs for telehealth vision care 

There are many great free and low-cost eye care programs for low-income families and individuals who may not have public or private vision insurance coverage. In addition to the ones listed by the US National Eye Institute, many local agencies and community health centers will also have low-cost vision care services. While these programs may not be designed specifically for telehealth eye care, this doesn’t mean they don’t utilize or offer virtual eye care services. More and more, virtual eye consults and AI tools are becoming part of the standard services that optometrists and ophthalmologists offer

One government agency that does offer specifically telehealth eye consults and vision care is the US Veterans Administration (VA). It currently offers three virtual eye care programs to assist veterans: 

Remote monitoring and AI for continuous vision care

The benefits of telehealth in ophthalmology don't have to stop after a virtual visit or remote consult. After patients receive, pay for, and follow treatment plans, their care can also be extended to follow-up appointments and remote monitoring  where eye care professionals can continue to watch how the patient is doing as a plan progresses. 

For example, modern platform-as-a-service (PaaS) solutions streamline this process by providing on-demand remote monitoring for specific eye conditions. PaaS company RemoniHealth offers AI-powered, personalized tools like Remoni EyeCoach to detect changes and recommend care pathways that eye care professionals can use to more intelligently manage eye and vision issues.

These tools and remote monitoring features can be especially useful for tracking the progression of diseases that cause vision loss, like glaucoma and age-related macular degeneration. It can also help ophthalmologists adjust the treatment of chronic eye conditions, like uncorrected refractive errors, over time. Remote monitoring via telehealth can thus improve outcomes for patients who may be unable to book physical follow-up appointments due to where they live, income restraints, mobility issues, or the time demands of their jobs. 

Chatbots and automation for digital eye care

Another viable eye care solution is the chatbot. The 2023 study Personalized Care in Eye Health: Exploring Opportunities, Challenges, and the Road Ahead for Chatbots notes these digital tools, which can be easily integrated into telehealth platforms, may serve as a patient's first line of contact when monitoring their eye conditions. From here, chatbots may decide to refer them for a virtual consultation and automatically upload the resulting data from their conversations into EMRs that ophthalmologists can access. 

Chatbots also overcome linguistic barriers that may prevent patients from seeking vision care, resolving eye care inaccessibility caused by language barriers—especially in the case of immigrants. They're also often available 24/7, which may come in handy for individuals who may not have time to inquire about any eye concerns during the work day. 

By facilitating frequent monitoring through remote channels such AI chatbots and digital health platforms, these telehealth solutions can allow for continuous and personalized ophthalmological care regardless of whether the patient can consistently return for physical follow-up appointments. 

Impacting Disparities with Tele-Ophthalmology and Tele-Optometry

One of the problems of tele-ophthalmology and tele-optometry is that these are still relatively unknown service options. A late 2023 news release from The Vision Council stated that for “34 percent of American adults, the primary reason they did not seek telehealth solutions for eyecare is because they had never heard of it.”  

This underutilization is especially concerning when it comes to reducing eye health disparities. When a patient lives in a remote or unsafe area, deals with a disability or mobility issue, or faces other barriers, utilizing telehealth eye care has the potential to make an impact on those affected by health inequality (low-income, Black and Hispanic minorities, etc.). It can help prevent higher incidences of blindness and eye disease, promote better eye health, increase health literacy, and ultimately, improve patient outcomes on the whole. 

1Original source: Updated National Survey Trends in Telehealth Utilization and Modality (2021-2022) released April 19, 2023

Guest post by Leanne Rose 



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