Screening is the next frontier in tele-retina

Telemedicine has been an emerging opportunity in the retina space for a while but with the lockdowns and safety measures brought on by the COVID-19 pandemic, its implementation was greatly accelerated, said Sophie Bakri, MD during a presentation at the Hawaiian Eye and Retina 2021 meeting.

During the initial shutdown in 2020, many patients delayed care, so out of necessity, a hybrid telemedicine model began to shape, helping patients limit the time they spent in the office and maximize the benefit of the treatments they were receiving.

By building off previous work, specifically on injection clinics, Dr Bakri said it was determined that vision screening and IOP needed to be taken at every visit and exams and optical coherence tomography (OCT) should be done after every few injections “to determine future intervals.” Previous studies on e-consultations for rural health found success in have a retina specialist determine the diagnosis and treatment plan and having a local ophthalmologist deliver the injections.

After an injection series, Dr Bakri said her team was able to offer a hybrid tele-retina model, opting for phone or video consultations with already established patients to determine the next interval.

“COVID hasn’t gone away but I’d say we learned to live with it,” she said. “We’ve gone back to regular face-to-face exams…but where does tele-retina fit in today?”

Dr Bakri said the next frontier for tele-retina is screening.

Drug toxicity screening has the potential to act as preventative medicine, she said, noting signs of a retina issue may be very subtle in drugs such as chloroquine, tamoxifen, pentosan, and thioridazine, and require a retina specialist over the patient’s established ophthalmologist.

In dry AMD, monitoring and screening are crucial, but retinal practices may not have the capacity to take on these patients depending on demographics and general ophthalmologists may be too busy treating other conditions.

“I believe the best model of care is really when you have an expert interpret the scans,” said Dr Bakri, who said drug toxicity and Dry AMD screening may be ideal for tele-retina in the future.

Reference
Bakri SJ. Tele-retina in the Management of AMD and Retinal Vascular Diseases. Presented at: Hawaiian Eye and Eye 2021.