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Association of Patient Characteristics With Delivery of Ophthalmic Telemedicine During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  During the first year of the COVID-19 pandemic in the US, were there differences in the characteristics of patients who received ophthalmic care via telemedicine compared with in-person care?

Findings  In this cross-sectional study of 1911 patients from a single academic ophthalmology practice, patients who were men, self-identified as Black, did not speak English, had an educational level of high school or less, and were of older age were less likely to receive telemedical care compared with in-person care.

Meaning  These results suggest that disparities in the delivery of ophthalmic telemedical care existed during the COVID-19 pandemic and support prioritizing health equity in future telemedicine programs.


Importance  Telemedicine has been shown to have had reduced uptake among historically marginalized populations within multiple medical specialties during the COVID-19 pandemic. An evaluation of health disparities among patients receiving ophthalmic telemedical care during the pandemic is needed.

Objective  To evaluate disparities in the delivery of ophthalmic telemedicine at Massachusetts Eye and Ear (MEE) during the COVID-19 pandemic.

Design, Setting, and Participants  This retrospective, cross-sectional study analyzed clinical visits at a single tertiary eye care center (MEE) from January 1 to December 31, 2020. Patients who had ophthalmology and optometry clinical visits at the MEE during the study period were included.

Exposures  Telemedicine vs in-person clinical encounters.

Main Outcomes and Measures  Variables associated with use of ophthalmic telemedicine during the study period.

Results  A total of 2262 telemedicine ophthalmic encounters for 1911 patients were included in the analysis. The median age of the patients was 61 (interquartile range, 43-72) years, and 1179 (61.70%) were women. With regard to race and ethnicity, 87 patients (4.55%) identified as Asian; 128 (6.70%), as Black or African American; 23 (1.20%), as Hispanic or Latino; and 1455 (76.14%), as White. On multivariate analysis, factors associated with decreased receipt of telemedical care included male sex (odds ratio [OR], 0.86; 95% CI, 0.77-0.96), Black race (OR, 0.69; 95% CI, 0.56-0.86), not speaking English (OR, 0.63; 95% CI, 0.48-0.81), educational level of high school or less (OR, 0.83; 95% CI, 0.71-0.97), and age (OR per year of age, 0.99; 95% CI, 0.989-0.998). When comparing telephone- and video-based telemedicine visits, decreased participation in video-based visits was associated with age (OR per year of age, 0.96; 95% CI, 0.94-0.98), educational level of high school or less (OR, 0.54; 95% CI, 0.29-0.99), being unemployed (OR, 0.28; 95% CI, 0.12-0.68), being retired (OR, 0.22; 95% CI, 0.10-0.42), or having a disability (OR, 0.09; 95% CI, 0.04-0.23).

Conclusions and Relevance  The findings of this cross-sectional study, though limited to retrospective data from a single university-based practice, suggest that historically marginalized populations were less likely to receive ophthalmic telemedical care compared with in-person care during the first year of the COVID-19 pandemic in the US. Understanding the causes of these disparities might help those who need access to virtual care.

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Article Information

Accepted for Publication: July 30, 2021.

Published Online: September 23, 2021. doi:10.1001/jamaophthalmol.2021.3728

Corresponding Author: Grayson W. Armstrong, MD, MPH, Department of Ophthalmology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA 02114 (grayson_armstrong@meei.harvard.edu).

Author Contributions: Dr Armstrong and Ms Moon had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Aziz, Moon, Parikh, Lorch, Miller, Armstrong.

Acquisition, analysis, or interpretation of data: Aziz, Moon, Parikh, Lorch, Friedman, Armstrong.

Drafting of the manuscript: Aziz, Parikh, Friedman, Armstrong.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Moon, Armstrong.

Administrative, technical, or material support: Parikh, Lorch, Miller, Armstrong.

Supervision: Aziz, Parikh, Lorch, Miller, Armstrong.

Conflict of Interest Disclosures: Dr Parikh reported receiving personal fees from Anthem Blue Cross Blue Shield during the conduct of the study. Dr Miller reported receiving personal fees from Alcon, Allergan PLC, ZEISS, Genentech, Inc, Sunovion Pharmaceuticals Inc, and Radius Health, Inc, outside the submitted work. Dr Armstrong reported receiving personal fees from Kriya Therapeutics, Ocular Technologies Inc, and the American Medical Association outside the submitted work. No other disclosures were reported.

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