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Outcomes of a Hybrid Ophthalmology Telemedicine Model for Outpatient Eye Care During COVID-19

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

Question  What are the outcomes associated with a hybrid ophthalmology telemedicine model, comprising an imaging appointment with a technician followed by a virtual appointment with a clinician, for patients with stable, nonprocedural eye concerns?

Findings  In this cross-sectional study involving 889 patients, no cases of irreversible vision loss were seen, and only 1.7% of patients required a subsequent in-person evaluation to clarify management. Hybrid visits were primarily for glaucoma (45.1%) and retinal issues (53.1%).

Meaning  These findings suggest that with the appropriate patient selection, the hybrid ophthalmology telemedicine model can be a good alternative to standard in-person visits, particularly for patients with glaucoma or retinal diseases.


Importance  The hybrid ophthalmology telemedicine model asynchronously pairs an imaging appointment by a technician with a subsequent virtual appointment by a clinician. Although it has been mentioned in several studies as an alternative to standard in-person care during the COVID-19 pandemic, outcomes of this alternative clinical care model remain to be evaluated.

Objective  To investigate the outcomes associated with the hybrid ophthalmology telemedicine model during the COVID-19 pandemic for nonurgent and nonprocedural ophthalmological care.

Design, Setting, and Participants  Retrospective, cross-sectional study of all hybrid visits scheduled during the year 2020 in a single academic, hospital-based eye clinic in Boston, Massachusetts. All hybrid ophthalmology telemedicine visits completed in the year 2020 by opthalmologists and optometrists were included. Data were analyzed from January to December 2020.

Exposures  Hybrid telemedicine clinical encounters.

Main Outcomes and Measures  Four outcome metrics were calculated: (1) need for subsequent procedure visit, (2) medication change, (3) nonurgent, and (4) urgent consultation with another eye clinician. Adverse outcomes were defined as irreversible vision loss and the need for additional in-person evaluation to reach a management decision.

Results  From April 9 to December 30, 2020, 889 patients (506 female patients [56.9%]; mean [SD] age, 62.1 [14.5] years; age range, 13-98 years) completed 940 hybrid visits. The most common visit indications were glaucoma (424 visits [45.1%]) and retinal diseases (499 visits [53.1%]). A total of 25 visits (2.7%) led to a procedure, 22 visits (2.3%) led to a change in medication, and 44 visits (4.7%) were referred for nonurgent consultation with another subspecialty with no instances of urgent referrals. Sixteen patients (1.7%) were referred to the on-call clinician for a same-day emergency in-person visit or recommended for a subsequent standard in-person visit to reach a management decision. There were no cases of irreversible vision loss following a hybrid visit.

Conclusions and Relevance  These findings suggest that with the appropriate patient selection and clinical setting, the hybrid ophthalmology telemedicine model may be a good alternative to standard in-person visits, particularly for patients with glaucoma and retinal diseases.

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Article Information

Accepted for Publication: June 23, 2033.

Published: August 25, 2022. doi:10.1001/jamanetworkopen.2022.26292

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Sanayei N et al. JAMA Network Open.

Corresponding Author: Xuejing Chen, MD, MS, Department of Ophthalmology, Boston University School of Medicine, 85 E Concord St, 8th Floor, Boston, MA 02118 (xuejingchen3@gmail.com).

Author Contributions: Dr Chen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sanayei, Albrecht, Ness, Siegel, Chen.

Acquisition, analysis, or interpretation of data: Sanayei, Albrecht, Martin, Marin, Fereshetian, Baker, Subramanian, Chen.

Drafting of the manuscript: Sanayei, Chen.

Critical revision of the manuscript for important intellectual content: Sanayei, Albrecht, Martin, Marin, Fereshetian, Subramanian, Ness, Siegel, Chen.

Statistical analysis: Sanayei, Albrecht, Chen.

Administrative, technical, or material support: Sanayei, Albrecht, Baker.

Supervision: Subramanian, Ness, Siegel, Chen.

Conflict of Interest Disclosures: None reported.

Meeting Presentation: A version of this study was presented at the virtual Annual Meeting of the Association for Research in Vision and Ophthalmology; May 7, 2021.

Additional Contributions: Frank Vavrek, MPH (Boston Medical Center), provided raw data for the project. No compensation was provided, and written permission was obtained to include him in the acknowledgment section.

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