Implementation of Telemedicine in a Retina Practice

The benefit to patients is worth the effort.


The COVID-19 pandemic has been a true test for our apparently fragile medical system in the United States. As retina specialists, we are privileged to care for patients with potentially blinding eye disease, and this has helped our retina-only practice in Denver, Colorado, survive in this uncertain climate. Necessary intravitreal injections and retinal detachments have sustained our significantly down-scheduled clinics, though we are seeing approximately 40% of our typical patient volume. The importance of “elective” medical care in our country and around the world has never been more apparent. For now, we, along with practices across our nation, are delaying appointments for patients with nonemergent conditions. The risk to our patients and the public have been too high to justify continuing routine in-person medical care.

Fortunately, adaptation and innovation are on our side. Seeing the impact of the COVID-19 pandemic on outpatient practices, the US Centers for Medicare and Medicaid Services quickly recognized that prior telemedicine regulations were far too restrictive to be practical and financially solvent. Many onerous rules were lifted to allow providers to rapidly adopt telemedicine into their practices. Although most patients with nonurgent retinal conditions can safely delay their care, we have found that there are several patients who have important questions about their symptoms, their treatment plan, and what they should be looking for. Although retina specialists are not yet able to remotely assess a posterior ophthalmic exam, telemedicine still allows us to provide patient-centered care that focuses on the less tangible aspects of medicine and the patient–provider relationship.

Our initial experience with telemedicine in our retina practice has been riddled with trial and error. Creating and optimizing workflows for our schedulers and billing department on the back end of our systems has allowed us to book patients, but this hasn’t always translated to seamless appointments. Our older patient population can make it difficult to coordinate video chatting and they have a habit of ignoring phone calls from phone numbers they don’t recognize. We initially utilized Zoom, Google Duo, and Facetime to facilitate video chatting. However, using this patchwork of teleconferencing platforms sometimes required that the patient know the personal account information or cell phone numbers for our doctors and this limited uptake. Our electronic health records system, Nextech’s ophthalmology-specific electronic health record, IntelleChartPRO, recently released a completely integrated telemedicine solution that has drastically simplified our ability to connect remotely with patients. With this system, patients receive a link via text and/or email that does not require an additional application or software to be installed on the phone or computer. Simply click and go. To ensure a seamless virtual appointment experience, our staff has been in close contact with patients prior to their appointments with text message and email reminders and detailed instructions on how to enter the virtual waiting room. This step in our workflow has been invaluable.

We have found our patients to be incredibly grateful to connect with us while we are at home or between patients in clinic. I recently videoconferenced with a functionally monocular patient of mine with new posterior vitreous detachment symptoms in his better-seeing eye. He recently had mild symptoms that were consistent with COVID-19, and we elected to avoid bringing him in to the clinic for the next week. After discussing his symptoms at length and advising him of the potential reasons he should call back until we could bring him in for a scleral depressed exam, he couldn’t thank me enough for taking the time to virtually meet.

As of now, telemedicine does not come close to matching the level of care we can achieve in clinic as retina specialists. Still, I can see a future where innovation with remote home-based imaging with OCT, fundus photography, and integrated telemedicine networks will integrate into the fabric of our practices. RP