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      Tele-ophthalmology: Need of the hour

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          Abstract

          Telemedicine and tele-ophthalmology have been in existence since many years, but have recently gained more importance in the present scenario of pandemic COVID-19. The attitude and perception of the doctors and patients has been changing gradually. Telemedicine has many advantages including providing care in inaccesible areas.In the present scenario, tele-ophthalmology gives an oppurtunity to patient for seeking consultation while also protecting against the contagion. There are many barriers faced by the patients and doctors that have restricted use of this technology in the past. However, with a systematic approach to designing the best suited technology, these barriers can be overcome and user friendly platforms can be created. Furthermore, the demand and use of teleconsulation had increased presently in this area of pandemic. Recent survey conducted by the All India Ophthalmological Society also reveals that many ophthalmologists who have not used tele-ophthalmology in the past are more keen to use it presently. In this article, we have reviewed telemedicine and tele-ophthalmology literature on Google and PubMed to get a holistic idea towards teleconsultation, its advantages, increased importance and prefrence during COVID-19 pandemic and various barriers faced so that the known challenges can be understood, which can pave way for better understanding and future incorporation into practice.

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          Most cited references51

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          Evaluating barriers to adopting telemedicine worldwide: A systematic review

          Introduction and objective Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to maximize the results.
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            Telehealth and patient satisfaction: a systematic review and narrative analysis

            Background The use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations. Objective The objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency. Methods Boolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE. Results 2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences. Conclusion This review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.
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              Virtual Ophthalmology: Telemedicine in a Covid-19 Era

              Purpose To discuss the effects of the SARS-Cov-2 betacoronavirus on ambulatory ophthalmology practices, the value proposition of telemedicine, tele-ophthalmology implementation methodologies, and the accelerated future of telemedicine. Design Review of the current telehealth landscape including usage, policies, and techniques for ambulatory practice integration. Methods We provide author-initiated review of recent trends in telehealth, governmental recommendations for healthcare delivery during the COVID-19 pandemic, and a PubMed Central query for telemedicine in ophthalmology or tele-ophthalmology. In addition, authors’ comprehensive experience in telemedicine design and implementation is provided. Results A summary describing the present state of telehealth, tele-ophthalmology modeling, care delivery, and the proposed impact of telehealth surges on the future of ophthalmology practice. Conclusion Recent patient and provider interest in telemedicine, the relaxation of regulatory restrictions, increased remote care reimbursement, and ongoing social distancing practices compels many ophthalmologists to consider virtualizing services.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Wolters Kluwer - Medknow (India )
                0301-4738
                1998-3689
                July 2020
                25 June 2020
                : 68
                : 7
                : 1328-1338
                Affiliations
                [1]Chairperson and Chief Ophthalmologist, Department of Ophthalmology, Tirupati Eye Centre, Noida, Uttar Pradesh, India
                [1 ]Cornea, Cataract and Refractive Surgeon, Department of Ophthalmology, Tirupati Eye Centre, Noida, Uttar Pradesh, India
                [2 ]CEO, Helyxon, Chennai, Tamil Nadu, India
                [3 ]Medical Superintendent, Manas Hospital, Noida, Uttar Pradesh, India
                [4 ]Editor, Indian Journal of Ophthalmology, Centre for Sight, Hyderabad, India
                [5 ]Dr. RP Centre for Ophthalmic Sciences, All India Institute of Ophthalmic Sciences, New Delhi, India
                [6 ]Chairman and Medical Director, Centre for Sight Group of Eye Hospitals, President, All India Ophthalmological Society, India
                Author notes
                Correspondence to: Dr. Mohita Sharma, Tirupati Eye Centre, C-53 C, Sector-33, Noida - 201 301, Uttar Pradesh, India. E-mail: drmohita@ 123456tirupatieye.org
                Article
                IJO-68-1328
                10.4103/ijo.IJO_1784_20
                7574128
                32587158
                f9640594-bae4-4ab9-b5c8-c1d6f4470b1a
                Copyright: © 2020 Indian Journal of Ophthalmology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 02 June 2020
                : 09 June 2020
                : 10 June 2020
                Categories
                Review Article

                Ophthalmology & Optometry
                barriers of tele-ophthalmology,pandemic,telemedicine guidelines,telemedicine,tele-ophthalmology

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