In Light Of Preparing For A New Landscape – Dealing With Chronic Eye Disease & COVID-19

In Light Of Preparing For A New Landscape – Dealing With Chronic Eye Disease & COVID-19

October 06, 2020

As far as reflecting on the COVID-19 pandemic is concerned, a singular emphasis on infection and associated death rates provides an incomplete picture. In every corner of the world, new health delivery models have been launched under great time pressure and difficult conditions to offer at least minimal care.

Because of the impact Covid-19 made on the well-being and socio-economic status of populations globally, undersupply and severe cutbacks in medical care are causing complications, more severe courses, loss of life quality, and more complex and risky treatments.

Although these undersupply and severe cutbacks are not directly the reason for high death rates, as far as infections and complications are concerned, they indeed may be considered game-changer in mortality rates.

The undersupply is clearly visible in ophthalmology. Only in the last six months, mainly because of fear, a 65 percent reduction in ophthalmic appointments seen throughout Europe. Weaknesses in care for common chronic conditions, such as AMD or diabetic retinopathy (DR) that – if left untreated – may lead to irreversible vision loss and blindness, are particularly the ones that these patients are at a high risk of serious illness from Covid-19.

Medical care in all parameters are poorly prepared for the unprecedented challenges of a pandemic. Although new health delivery models have been launched under great time pressure and difficult conditions to offer at least minimal care, the focus of these initiatives was always on bringing medical care to the patient but not, as usually the case, bringing the patient to the care center.

Although many emergency plans were proposed and, in some cases, already implemented in the pandemic, there is still a lot to be done on digital health approaches, such as telemedicine, virtual clinics, and home monitoring. These applications have great potential to improve access to medical care and efficiency of care pathways even outside of pandemics.

Many organizational and political steps are necessary to effectively introduce these innovations into care. These activities should include the involvement of non-medical specialists, such as opticians, optometrists, and medical-technical practice assistants, who can provide delegated services.

In light of the need for more interdisciplinary and transdisciplinary collaboration, implementing essentials to demonstrate the safety, efficiency, and sustainability of such care pathway transformations is a must.

Generating a high-quality experience – evidence is a time-consuming process, that’s why initiatives have to be launched quickly. The big need to limit and minimize vision loss during the pandemic requires the rapid deployment of innovative care pathways on a pilot basis, providing preliminary evidence of their potential.

Excellent medical care for chronic eye diseases needs training and direct access to professional input from hospital-based medical experts.

Based on the experiences it is known that shared care by hospital-based optometrists and specialist eye nurses to monitor chronic eye disease may be equivalent to ophthalmic care in certain circumstances.

Role of Telemedicine

Telemedicine makes patients reach medical care remotely, reducing unnecessary and costly hospital visits, and optimizing access to medical care. It also enables referrals to be made by remote verification of the imaging performed close to the patient by hospital-based experts.

The technical requirements for this kind of medical care are already known and have been implemented on a small scale in projects. Evidence from robust prospective validation research will guide meaningful implementation of such pathways at scale, and a small number of such initiatives are already underway.

In this sense, international funders are called for more investments. After the Covid-19, the digitally-enabled eye care would need more detailed research in terms of redesigning eye care services.

Additionally, the time-consuming image evaluation by clinical experts can be partially replaced by AI-supported decision aids for the triage of referrals. Analyses in this context have proven that automated classification of OCT scans and fundus images with new algorithms is equivalent to expert assessment for AMD and DR screening.

After the pandemic, collaboration between community optometry and hospital-based eye services will be needed when it comes to absorbing the expected capacity pressures.

In these Covid-19 tribulation times, home monitoring of vision could provide the only remaining option for surveilling the vision of vulnerable patients with AMD and DR who are self-isolating or can not access hospital and community-based eye care.

With the help of technological innovations, completely new forms of ophthalmic care are now possible. A well-planned telemedicine practice, decentralized diagnostics, algorithmic processing of image data makes it possible to transform eye care provision.

The consequences of late intervention usually lead to suffering and patient illness that could be avoided with good planning. This is the time to act by implementing new care pathways to minimize the impact of the pandemic on preventable vision loss, and also by prioritizing research that will provide the evidence on efficiency and sustainability of an entirely new eye care landscape.