Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA.
College of Medicine, University of Arizona, Tucson, Arizona, USA.
J Telemed Telecare. 2022 Oct;28(9):670-679. doi: 10.1177/1357633X20960636. Epub 2020 Sep 29.
COVID-19 has disrupted how ophthalmic practice is conducted worldwide. One patient population that may suffer from poor outcomes during the pandemic are those with age-related macular degeneration (AMD). Many practices are performing some form of tele-ophthalmology services for their patients, and guidance is needed on how to maintain continuity of care amongst patients with AMD using tele-ophthalmology.
A literature search was conducted, ending 1 August 2020, to identify AMD outcomes and telecare management strategies that could be used during the COVID-19 pandemic.
237 total articles were retrieved, 56 of which were included for analysis. Four American Academy of Ophthalmology and Center for Disease Control web resources were also included.
Risk-stratification models have been developed that let providers readily screen existing patients for their future risk of neovascular AMD (nAMD). When used with at-home monitoring devices to detect nAMD, providers may be able to determine who should be contacted via tele-ophthalmology for screening. Telemedicine triage can be used for new complaints of vision loss to determine who should be referred to a retinal specialist for management of suspected nAMD. To increase access and provider flexibility, smartphone fundus photography images sent to a centralized tele-ophthalmology service can aid in the detection of nAMD. Considerations should also be made for COVID-19 transmission, and tele-ophthalmology can be used to screen patients for the presence of COVID-19 prior to in-person office visits. Tele-ophthalmology has additional utility in connecting with nursing home, rural, and socioeconomically disadvantaged patients in the post-pandemic period.
COVID-19 扰乱了全球眼科实践的开展方式。在大流行期间，可能有一类患者会出现较差的治疗效果，即年龄相关性黄斑变性（AMD）患者。许多机构正在为其患者开展某种形式的远程眼科服务，因此需要指导如何在 COVID-19 大流行期间利用远程眼科来维持 AMD 患者的护理连续性。
进行了文献检索，截至 2020 年 8 月 1 日，以确定在 COVID-19 大流行期间可用于 AMD 患者的治疗效果和远程护理管理策略。
共检索到 237 篇文章，其中 56 篇被纳入分析。还纳入了美国眼科学会和疾病控制中心的 4 个网络资源。
已经开发了风险分层模型，使提供者能够轻松筛查现有患者未来发生新生血管性 AMD（nAMD）的风险。当与用于在家中监测 nAMD 的设备结合使用时，提供者可能能够确定谁应该通过远程眼科进行筛查。远程医疗分诊可用于新的视力丧失投诉，以确定谁应转诊给视网膜专家以管理疑似 nAMD。为了增加可及性和提供者的灵活性，可以使用智能手机眼底照相图像发送到集中的远程眼科服务，以帮助检测 nAMD。还应考虑 COVID-19 的传播，并且可以使用远程眼科在进行亲自就诊之前筛查患者是否存在 COVID-19。在大流行之后，远程眼科在与疗养院、农村和社会经济弱势群体患者建立联系方面还有其他用途。
