Tips for Improving Your Telemedicine Visit for Glaucoma

This article will help guide you on what to expect during an ophthalmology telemedicine appointment, and how to improve your video visit with a health care provider.

A “New Normal”

All of us in medicine are adjusting to the “new normal” in delivering health care to our patients, and it may be some time before ophthalmology practices can return to “business as usual.” The coronavirus pandemic has led to disruptions in routine scheduled in-person appointments throughout all fields of medicine.

You may wonder whether a video visit will be useful if your ophthalmologist cannot examine your eyes, but there is a lot still that can be accomplished during a telemedicine visit.

This article will focus on glaucoma care, but some of what is discussed here will apply to other ophthalmology subspecialties.

Everyone can appreciate the fact that for some time, in most states, ophthalmology practices were not scheduling routine, non-urgent visits. This means that even once clinics reopen, there will be challenges in scheduling. Not only will there be a large number of patients whose original visits were cancelled, but also the number of patients that can be seen in clinic will necessarily be reduced. This is because practices will still likely try to maintain physical distancing and avoid crowded waiting rooms. There may be new models of care delivery which will be discussed below. But it is important to recognize that a video visit may be a suitable interim solution when access to the clinic is limited or challenging.

Steps to Take Prior to Your Telemedicine Visit

Test the Technology

Before the day of your scheduled video visit, you should test out your computer, tablet or phone for the appropriate hardware and software setup used by your provider, who will give you information on how to connect for the telemedicine visit. Ideally you can try connecting prior to your visit, although you may not be able to receive feedback as to whether your video or audio connection is working until the day of the visit.

If technology is not your forte, you can ask a family member or friend to help troubleshoot. But do not worry, even if you and your ophthalmologist encounter technical problems, you can always revert to a telephone visit, and many issues can be resolved over the phone.

Prepare Notes for Your Visit

In addition to addressing your specific issues, a telemedicine visit provides an opportunity for you to connect with your ophthalmologist and make plans for the future. You may be able to troubleshoot issues with your provider, such as difficulties obtaining enough eye drops each month or addressing side effects from these medications. In addition, your ophthalmologist can obtain a lot of information from you by discussing your symptoms.

Symptoms

Come prepared to your telemedicine visit and be ready to describe any symptoms you may be having. You can make notes about any pain, vision change, tempo or other characteristics of the symptom, triggers, and associated symptoms.

Changes in Medications

In addition, you will want to inform your provider if you are taking any new medications or have any new health updates. It is also helpful to have your eye medications handy, and to have the bottles in arm’s reach in case there is any confusion about your regimen. Finally, have your list of questions ready to discuss with your ophthalmologist.

The Examination

In terms of what components of your usual eye examination that may take place, your ophthalmologist will have reviewed your medical record prior to your telemedicine visit, just as they would do in clinic. Some ophthalmologists may take a visual acuity measurement and perform an external eye exam.

For glaucoma care, one of our major exam components is careful visualization of the optic nerve, which is not typically possible over a video visit. However, I have seen some ingenious attempts and by the time this article is published it may be possible that this statement is no longer true!

Next Steps and Plans for Future Visits

Once your ophthalmologist has made an assessment, they will summarize next steps and plan for your future visit. They may advise you to make medication adjustments. If you were planning on returning to the clinic (prior to the pandemic) for laser glaucoma treatment, they may advise adding an eye drop in the interim, just to be safe. A video visit will also give you an opportunity to discuss laser and surgical treatments with your ophthalmologist if they are being considered.

Finally, your ophthalmologist may update you on how their practice will move forward in the “new normal.” They may advise you that visits in person will be limited to tests that cannot be performed at home or during a video visit, and then any discussions about your care may take place over a video visit to limit your time in the clinic.

You can ask about what to expect when you return to the clinic. Some new policies may include screening questions about risk factors over the phone before you arrive at the clinic, wearing a mask once inside the clinic, and limiting the number of visitors. You can expect enhanced disinfection practices, physical shields on equipment to protect you and the provider or staff during exams, physical distancing in the waiting room, “car waiting” where instead of sitting in the waiting room you remain in your car, and special policies and/or clinic areas for patients who are sick and need to come to the clinic.

Be assured that your eye care remains a top priority for your ophthalmologist, as well as your safety. While a telemedicine visit may not entirely replicate an in-person visit that you used to have with your ophthalmologist, it can be very helpful in managing your eye care during this global pandemic.