Authors:Jingyi (Jenny) Ma, Mariam Issa, Iqbal Ahmed. University of Toronto.

Author Disclosure Block:J. Ma: None. M. Issa: None. I. Ahmed: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Aequus, Aerie Pharmaceuticals, Akorn, Alcon, Allergan, ArcScan, Bausch Health, Beaver Visitec, Beyeonics, Camras Vision, Carl Zeiss Meditec, CorNeat Vision, Ellex, ELT Sight, ElutiMed, Equinox, Genentech, Glaukos, Gore, InjectSense, Iridex, iStar, Ivantis, Johnson & Johnson Vision, KeLoTec, LayerBio, Leica Microsystems, MicroOptx, MST Surgical, New World Medical, Ocular Instruments, Ocular Therapeutix, Omega Ophthalmics, PolyActiva, Sanoculis, Santen, Science Based Health, Sight Sciences, Stroma, ViaLase, Vizzario. Any direct financial payments including receipt of honoraria; Description of relationship(s); Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees, Consultant/Consulting Fees. Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Alcon, Allergan, Carl Zeiss Meditec, Johnson & Johnson Vision, MST Surgical, Mundipharma. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Speakers Honoraria, Speakers Honoraria, Speakers Honoraria, Speakers Honoraria, Speakers Honoraria, Speakers Honoraria. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Aerie Pharmaceuticals, Alcon, Allergan, Camras Vision, Glaukos, Ivantis, Johnson & Johnson Vision, New World Medical, Santen. Funded grants or clinical trials; Description of relationship(s); Research Grant/Support, Research Grant/Support, Research Grant/Support, Research Grant/Support, Research Grant/Support, Research Grant/Support, Research Grant/Support, Research Grant/Support, Research Grant/Support.

Abstract Body:

Purpose: The COVID-19 pandemic has presented a challenge to current models of healthcare delivery. Ophthalmologists are at significant risk for potential SARS-CoV-2 transmission given their close proximity during examinations. We aim to evaluate the effectiveness and safety of a virtual ophthalmology assessment system implemented in response to COVID-19.
Study Design: Retrospective, consecutive cohort study.
Methods: All virtual ophthalmology assessments conducted from April 15 to May 15, 2020 at Prism Eye Institute in Toronto, ON, Canada were reviewed. Patients were tele-triaged to 4 possible initial assessment pathways: email, phone call, phone call and face to face visit, or phone call and referral to another physician. We administered a telephone survey to gauge patient safety and satisfaction for all patients who requested a virtual assessment during this time period. Our primary outcome measures were: 1) proportion of patients who required additional in-person visits to the emergency room or to an external clinic and 2) incidences of compromised care from patient-reported delayed diagnosis, treatment, or surgery.
Results: 759 virtual assessments were performed with a mean age of 55. Of the triage pathways, 14% received an email, 74% received a phone call, 10% required a face to face visit and 2% were referred elsewhere. Presentations were most commonly cornea/anterior segment and retina. They were non-urgent in 68% of cases and no pharmacologic treatment was required for 49%. After receiving a virtual assessment and being advised that an in-person visit was not necessary, 4% went on to the emergency room and 17% sought another in-person doctor, after which 4 patients underwent urgent retinal surgery. Subjectively, 7% of patients reported feeling as if they received a delayed diagnosis, treatment or surgery.
Conclusions: As in-person visits are limited during the COVID-19 pandemic, tele-ophthalmology provides an opportunity to continue patient care while minimizing risks to patients and health care providers. Virtual assessments have the potential to prevent unnecessary in-person visits, but caution must be exercised to not miss vision-threatening conditions.