In this age of precision medicine and robotic surgery, telemedicine has largely remained on the back burner — a victim of stringent regulations and restrictions on physician reimbursement. Until now. In an effort to facilitate doctor visits during the coronavirus pandemic, Congress and the Centers for Medicare and Medicaid Services recently loosened restrictions on how telemedicine can be implemented and paid. Many private insurers have followed suit, indicating that they, too, will pay for virtual visits. These changes, combined with concern that in-person visits could jeopardize the health of patients, clinicians and staff, have created a boon in telemedicine use.

Telemedicine, aka video appointments, can help decrease the overall risk of spreading the coronavirus, but they’ve proven especially beneficial for older Wilmer patients, who are at high risk of becoming seriously ill, should they become infected. Michael Repka, M.D., vice-chair for clinical practice at Wilmer Eye Institute, Johns Hopkins Medicine, says the more people we can care for without their having to make the trip to Wilmer, the better off we all are.

At Wilmer, clinicians are using virtual care to assess conditions such as conjunctivitis, blepharitis and cellulitis, as well as assessing eye movement for double vision. Repka says virtual visits can also be useful for follow-up visits after external eye surgery but adds that not every eye condition lends itself to telemedicine. “We can measure visual acuity loss and do front-of-the eye exams, but we can’t do refractions. We can’t assess a retinal issue or a cataract issue, but we can do telephone triage, and we can avoid requiring some people to come to the office.”

Part of the challenge, says Repka, is that the field of ophthalmology often requires the use of handheld tools and imaging to see things inside the eye. Other challenges relate to the technology itself. Along with issues such as determining which platform to use, telemedicine requires instruction for both physicians and patients on how to use it.

Repka admits that adapting to using telemedicine — and having to implement it so quickly — has required a bit of a learning curve, but he sees doctors and patients rising to the challenge. “There are technical glitches, where, for example, a family or doctor will lose their internet connection or inadvertently make a mistake while using the software. But I will say that just within a week, more people have become familiar with the Zoom and Facetime platforms than ever before,” he says, adding, “Incidentally, these have been simpler for patients to use than some of the EHR [employee health record] platforms.”

Although virtual medicine has become more mainstream by necessity, it’s unclear whether or not it will become standard practice for certain types of care. Regardless, says Repka, “Now that some patients have experienced it and recognize what you can and can’t do with it, I’m sure there is no going back.” He considers the current situation an impetus for rethinking how the technology can be used and for innovation across platforms. “What I think we will see is expansion of apps and other things that can help with some of the exam elements. The ability to measure vision or perform refraction online — those would be the real things that need to be tweaked, so that we can do the exam even better. I think people are going to get very clever at how we can image."

In the meantime, ophthalmologists from Wilmer and other institutions have joined forces to establish a communication network where providers can share best practices in telemedicine adaptation, particularly as they relate to COVID-19. Beyond the pandemic, however, they plan to continue to combine resources and knowledge about telemedicine through an online platform called TeleVision MD.