Limitations of telemedicine

The COVID-19 pandemic offers ophthalmologists a chance to re-evaluate the way they run their practices and treat their patients more efficiently in the longer term, he said. Speaking during a special webinar organised by the Intravitreal Expert Group, Dr Monés, Director of the Macula and Retina Institute, Barcelona, Spain, said that the profession needs to be proactive in adapting to an evolving situation. “This is a good chance for us to optimise a lot of our procedures and to revisit our way of doing things and make changes where necessary. We also need to work on education and marketing to encourage our patients to overcome their anxiety around COVID-19 and seek treatment. Otherwise we will have a lot of visual casualties that could have been prevented,” he said. There are several key challenges ahead, said Dr Monés. “We need to organise our clinics so that every single detail from the time the patient arrives until they leave will be geared to preventing infection. The second thing will be to convince patients of all these measures to protect them and that they will be in an environment which is COVID free. We will also need to be much more efficient if we want to see the same number of patients as a result of all these measures being put in place to ensure their safety. We will need to be more productive and to make every moment count,” he said. Dr Monés added that while flexibility and adaptation are important assets in the current crisis, ophthalmologists should be wary of introducing radical changes to their treatment protocols. “What I would not like to do is to jeopardise our current good practices because of adapting too much to COVID-19. For example, we need to be careful about changing our patients’ injection schedules in the name of efficiency. We know that deferral of intravitreal injections of even a few weeks with certain types of retinal disease can lead to reactivation, so we need to be extremely careful and proceed on a case-by-case basis,” he said. As one of the countries with the highest rates of infection and mortality from COVID-19, the response from the Spanish government was a very strict lockdown to flatten the curve, said Dr Monés. “As a health centre we were not locked down by law because we were deemed an essential service. But because all the population was asked to stay home, we actually had no patients to treat. We had a dilemma what to do with our high-risk patients. Some colleagues advised not treating patients until they lose vision. However, I don’t think the virus justifies people losing vision,” he said. Dr Monés and his staff drew up a crisis plan and studied all the patient charts to decide which patients should continue to receive treatment. “That triage was a lot of responsibility because we were taking vulnerable people from their homes to administer treatment, but we considered that the risk of losing vision was worse than the risk of contracting COVID-19. We took extensive hygiene measures even before the authorities asked for it because we were very conscious that these patients were fragile and that we are in close proximity to them for treatment,” he said.  

Tags: covid-19 telemedicine