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

Symptoms of Eye Emergencies

During the pandemic, the American Academy of Ophthalmology and the Centers for Disease Control and Prevention, have mandated that your eye doctor limit practice to those patients with eye emergencies or urgencies. Elective surgery has been postponed.

There are several warning signs or symptoms which should alert you to call your eye doctor.

Pain

Eye pain can be caused by a corneal abrasion, inflammation or advanced glaucoma.

Corneal abrasions may also be associated with tearing, redness and blurry vision. The corneal is ultra sensitive and even a slight abrasion can be painful. The corneal surface allows for about 2/3 of the total focusing power of the eye. If the surface becomes abraded, blurred vision is common.

Inflammation, such as iritis, causes pain, redness, sensitivity to light and blurry vision. Advanced glaucoma can lead to uncontrolled eye pressure causing pain, redness, tearing, nausea and decreased vision.

Eye pain associated with redness should prompt a call to your doctor. Almost any and every “eye related” cause of eye pain involves redness.

Sudden Decreased Vision

Sudden decreased or vision loss can be an emergency.

Most retinal diseases can cause sudden and painless vision loss, such as:

While there are other causes, I’m listing the common causes of acute vision loss from retinal diseases.

Sudden Distortion

Distortion is usually caused by a macular problem.

While distortion is a common complaint in patients with macular holes or epiretinal membranes, the onset is usually gradual and not acute.

Acute distortion can be from macular edema (swelling) from an retinal vascular occlusion or leakage/bleeding from wet macular degeneration. Sometimes a retinal detachment can cause distortion, but this is usually associated with complaints of loss of peripheral vision.

Exacerbation of wet macular degeneration is certainly an emergency and may require prompt treatment with anti-VEGF medications.

If you are experiencing pain, loss of vision or new distortion, make sure to call your eye doctor or retina specialist.

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

Retinal Disease Urgencies & Emergencies

As the pandemic looms, do you know what urgent and emergent eye conditions might mean?

Eye doctors will likely be asked to see only patients with urgent and emergent conditions. Retinal diseases often require emergent or urgent treatment.

Suggestions have been made to limit office visits to those patients with only urgent and emergency conditions.  In addition, hospitals have been canceling elective surgery and procedures to a later date. Both measures are intended to protect healthy individuals from unnecessary exposure to the virus and to preserve healthcare resources.

Retinal specialists treat “urgent” and “emergent” on a daily basis.  Here’s a short list of what a retina specialist treats on a daily basis.  

Disclaimer:  This article reflects my opinion only.  Your own doctor may have a different opinion.  Please check with your doctor if you have questions or if you are having problems with your vision.  In my opinion, any condition which causes a change in vision or pain should warrant an urgent visit to your doctor….call your doctor.  

N. Moinfar, M.D.

Diabetic Retinopathy

Diabetic retinopathy is the disease diabetes causes in the eye.  Most patients will develop some degree of diabetic retinopathy in their lifetime, and because of this, patients need to be seen regularly whether there are changes in their vision or not.

If there are no acute changes in vision since last visit, then there is probably no urgency to get an examination, though this may not be true in patients with proliferative diabetic retinopathy.  You may call your doctor and discuss how long you can wait after the pandemic is over. 

Diabetes can cause sudden loss of vision due to a vitreous hemorrhage.  Your doctor may want to see you quickly.

New Onset Floaters

Usually new onset floaters are due to a posterior vitreous detachment (PVD).  A PVD can cause a retinal tear which can be diagnosed only by prompt examination and, therefore, new onset floaters should be deemed urgent.  Retinal tears can cause a retinal detachment, hence, the concern.

Macular Degeneration

Patients with macular degeneration can develop loss of central vision and/or distortion.  Many patients self monitor at home with the aid of an Amsler grid, a simple way to look for new distortion in their vision.  If you notice new loss of vision and/or worsening distortion, especially if you are receiving anit-VEGF injections, I would recommend you call your doctor for an urgent evaluation.

Complications from Cataract Surgery

Complications from cataract surgery are usually seen by a retina specialist within a few days of occurrence.  Since cataract surgery is deemed elective, there should not be any complications during the pandemic as cataract surgery is being rescheduled to preserve hospital resources and decrease exposure of healthy people to the virus. 

Retinal Detachment

Retinal detachments can be an emergency, especially if there is progressive loss of vision, but the central vision is spared.  The goal of retinal detachment surgery is to diagnose and perform surgery before the central vision is affected.  

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