The Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
J Binocul Vis Ocul Motil. 2021 Jul-Sep;71(3):110-117. Epub 2021 Aug 4.
The coronavirus (COVID-19) global pandemic has been a poignant reminder of the value of telehealth services to deliver care, especially as a means of reducing the risk of infectious disease transmission caused by close personal contact, decreasing unnecessary travel for medical consultations, and limiting the number of individuals in waiting rooms. The role of telehealth in ophthalmology has historically been limited to store-and-forwarding of images, much like what is used in radiology.
Remote evaluation using two-way audio-video communications over the initial 10-week period of clinic shutdowns. Visual acuity (VA) measurement was attempted using a printed single surrounded HOTV or Snellen chart. The VA measurement of fellow eyes was compared to the prior in person clinical visit. External and strabismus examinations were also conducted.
Fifty-eight patients were evaluated with a mean age 12.5 years (range 5 months to 82 years). Twenty of 58 (34%) were younger than 5 years of age. Reasons for evaluation were strabismus in 26 patients (45%), refractive error in 25 (43%), and amblyopia in 10 patients (19%). Recognition visual acuity was obtained in 69% (40 of 58), including every patient older than 5 years of age. Nine children from 2 to 5 years of age (mean 3 years) were unable to perform HOTV VA testing. Of nine children unable to do complete VA testing, five had been premature and seven had developmental delay. There was a mean bias of -0.12 logMAR in favor of the prior in office test in the right eyes of 21 non-amblyopic patients. The 95% limits of agreement between the in-person visit and the subsequent telehealth video visit logMAR VA were +0.20 logMAR upper limit, -0.44 logMAR lower limit.
Telehealth video visits provided basic ophthalmic information in patients who are physically incapable to come to the office, leading to improved triage. Vision could be tested remotely in young children, but we found substantial variability in the measurement of clinically normal eyes. Improvements in the reliability of at-home visual acuity testing are needed.
冠状病毒（COVID-19）全球大流行深刻提醒了人们远程医疗服务的价值，特别是作为降低因密切身体接触而传播传染病风险、减少医疗咨询不必要出行以及限制候诊室人数的手段。远程医疗在眼科的作用历史上一直局限于图像的存储和转发，就像放射科那样。
在诊所关闭的最初 10 周内，通过双向音频-视频通讯进行远程评估。使用打印的单周边 HOTV 或 Snellen 图表尝试测量视力（VA）。比较对侧眼的 VA 测量值与之前的亲自临床就诊。还进行了外部和斜视检查。
评估了 58 名患者，平均年龄 12.5 岁（范围 5 个月至 82 岁）。20 名患者（34%）年龄小于 5 岁。评估原因包括斜视 26 例（45%）、屈光不正 25 例（43%）和弱视 10 例（19%）。69%（58 例中的 40 例）获得了识别视力，包括所有年龄大于 5 岁的患者。9 名 2 至 5 岁的儿童（平均 3 岁）无法进行 HOTV VA 测试。在无法进行完整 VA 测试的 9 名儿童中，有 5 名早产儿，7 名发育迟缓。21 名非弱视患者的右眼在之前的办公室测试中平均偏倚为-0.12 logMAR。在门诊就诊和随后的远程医疗视频就诊 logMAR VA 之间，95%的一致性界限为上界+0.20 logMAR，下界-0.44 logMAR。
远程医疗视频访问为无法亲自到办公室就诊的患者提供了基本的眼科信息，从而改善了分诊。可以远程测试年幼儿童的视力，但我们发现正常临床眼睛的测量存在很大差异。需要提高家庭视力测试的可靠性。
