Telemedicine for Retina Specialists

Ready for telemedicine? Here’s what you need to know to get prepared…if it’s available at all from your doctor.

It’s May 2020 and we are in the midst of the pandemic.  In most states, stay at home orders have been in effect for about 6 weeks and healthcare has been moving along with guidelines designed to not stress our healthcare system.

In March, the American Academy of Ophthalmology and Centers for Disease Control and Prevention made strong recommendations to ophthalmologists to reduce patient care to those with urgent and emergent conditions.

About the same time, the American Academy of Ophthalmology and CMS introduced several changes to promote the use of telemedicine as an alternative to face-to-face examinations.  The idea is to reduce COVID-19 exposure to ourselves, our staff and patients. 

What is Telemedicine?

Until the pandemic, telemedicine was probably used loosely to refer to the remote screening and management of patients.  Telemedicine has the potential to help patients in remote areas (rural communities, war zones) where healthcare is sparse.  Telemedcine has the potential to screen and triage patients, but since the pandemic, telemedicine might substitute as an office visit if you are unable or unwilling to expose yourself to others who might be infected. 

Most commonly, telemedicine uses our phones and computers to create audio-visual connections between patients and providers.

While the exact platforms (digital programs) vary from office to office, a connection providing audio and visual information is at the core of effective telemedicine.

Common platforms for telemedicine include:

  • Face Time
  • Facebook Messenger Video
  • Google Hangouts
  • Zoom
  • Go-to-Meeting 
  • Skype
  • Others

Many of us are already using these platforms for connecting with friends, family and business colleagues.  Ask your own doctor/healthprovider to see what platforms they are using.

What You Need for Your “Appointment”

In most cases, you’ll need your smart phone.  While an Internet connection and a computer may suffice, it may add technical complexity to speaking with your provider.  

In addition to having the proper digital tools, be prepared to have or do the following:

  • Give consent to the telehealth visit (minors need parental permission)
  • Current health problems and details
  • Medical history
  • List of medications
  • Knowledge of operating your device (e.g. can you take a selfie?)

Your eye doctor may be able to check your vision remotely and examine different parts of your eyes and face.  You will likely need to assist by changing positions and changing camera angles.  For ophthalmology, taking a “selfie” may be necessary.

Your provider should have a discussion with you – be prepared by having a list of questions ready before starting the visit. 

Your provider may ask you to follow up with pictures, emails or texts.  

Telemedicine for Retina Specialists

Telemedicine works better for some specialists and not as well for others.   For instance, telemedicine probably works great for psychiatry, but perhaps not as well for dentistry.

Similarly, a retina specialist may have more difficulty fully utilizing the advantages of telehealth because patients must have a dilated exam.  While there are screening devices available to avoid a dilated eye exam, these devices are available on a commercial basis and not available for home use.

In general, for a retina specialist to best examine and diagnose your retinal problem, dilating the pupils, optical coherence tomography and fluorescein angiography may need to be completed which requires a trip to the office.

Still, if you are having symptoms, such as acute loss of vision or pain, you may start your journey by calling your eye doctor to see if a telemedicine visit is right for you.

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

Possible COVID-19 Treatment can Cause Eye Damage

Hydroxychloroquine is FDA approved for certain autoimmune diseases and malaria, but has the potential for toxicity…

Hydroxychloroquine has long been used to safely treat patients with malaria and certain autoimmune diseases such as lupus erythematosus and rheumatoid arthritis, but NOT COVID019.

In the news, there have been small, inconclusive studies using two malaria and autoimmune medications to treat COVID-19 (coronavirus 2019). Some studies suggest the medications might be helpful, while other studies saw no difference.

Currently, there is not enough medical data to prove that hydroxychloroquine and chloroquine work for COVID-19.

Hydroxychloroquine Approved for Malaria

Chloroquine was approved by the FDA in 1949 as a treatment for malaria, an infection caused by a parasite. Hydroxychloroquine was approved by the FDA in 1955 for the treatment of malaria. Hydroxychloroquine is preferred over chloroquine because it has fewer side effects.

Both drugs are available in pill form. Plaquenil is also approved for long-term use in rheumatoid arthritis and lupus.

The side effects of both medications include:

  • Retinal damage and irreversible vision loss (Plaquenil Toxicity)
  • Headache
  • Abnormal heart rhythm
  • Muscle weakness or nerve pain
  • Gastrointestinal issues (nausea, cramping, vomiting, and diarrhea)
  • Hypoglycemia (low blood glucose)
  • Worsening of psoriasis

Retinal Damage | Plaquenil Toxicity

The overall prevalence of chloroquine/hydroxychloroquine retinopathy is 7.5%. Retinal damage is one of the most serious adverse effects of hydroxychloroquine (HCQ) since the retinal damage caused by the drug is irreversible. Chloroquine/hydroxychloroquine retinopathy is more common with higher daily doses and long-term use.

A baseline retinal examination is recommended for all patients taking HCQ, along with regular monitoring examinations. The baseline and monitoring examinations should include the following:

  • Uncorrected visual acuity test
  • Best-corrected visual acuity test
  • Examination with ophthalmoscope
  • Examination using slit-lamp
  • Optical Coherence Tomography

The FDA previously issued an Emergency Use Authorization (EUA) that allows physicians to request a supply of hydroxychloroquine or chloroquine for hospitalized patients with COVID-19 who are unable to join a clinical trial. 

As of this writing 4/24/20, the FDA now warns against the use of hydroxychloroquine for the treatment of COVID-19 after reports of irregular heart rhythms and deaths.

If you are presently taking Plaquenil, talk to your prescribing doctor to insure that you are getting regular eye exams.

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

Jon Doe