A pilot study on the perspectives of pediatric ophthalmologists and their patients towards online consultation during COVID-19 lockdown in India.

Dear Editor:

Tele-ophthalmology for individualized patient care was un-common until recent national lock-down when regulatory and practice guidelines were made available.[12] We present the perspectives of the pediatric ophthalmologists (PO) and their patients towards tele-ophthalmology, captured in the initial 6 weeks of this new era of legalized Telehealth.

A 15-item questionnaire for PO was administered through google forms and an eleven item questionnaire for patients was administered via a telephonic-call [Table 1]. All the patients were treated by chief author. Teleconsultations and online payments were legally compliant.

Table 1

Questionnaires used for the assessment of the perspectives of the pediatric ophthalmologists and their patients towards individualised patient care using tele-ophthalmology

Questionnaire for Pediatric ophthalmologists.
1	Please mention your age in years
2	Please mention your gender
3	Describe your role as pediatric ophthalmologist
4	How many years have you been in the practice?
5	Do you offer teleophthalmology services in your practice?
6	Are you aware of the Indian teleophthalmology or telemedicine practice guidelines published by the medical council or health ministry or AIOS?
7	Do you know how to set up a teleophthalmology practice compliant with the current regulations?
8	In which situations would you recommend a teleophthalmology consultation to the patients?
9	What could be the other possible indications for use of teleophthalmology in your practice?
10	In which situations would you strongly discourage the use of teleophthalmology?
11	Which type of virtual consultation would you prefer with your patients?
12	What is your current consultation fees for clinic consultation?
13	What should be the optimal fees for your online consultation?
14	What are your major concerns regarding integration of teleophthalmology in your practice?
15	Would you consider integration of teleophthalmology services in your practice?
Questionnaire for the patients
1	Which mode of online consultation did you avail?
2	Which type of consultation was this?
3	What is the age of the patient?
4	What is your overall satisfaction with the recent online consultation? [0 being extremely unsatisfied and 5 being extremely satisfied]
5	Would you be willing to resuse the same mode of consultation in future?
6	How reliable you felt about utilising this mode of consultation for the current problem?
7	Did the consultation help address your problem?
8	In which situations do you advise to use online consultation?
9	What are the other situations where you recommend online consultation?
10	Are you aware of any strict guidelines that doctors follow for online consultation pertinent to quality of care, patient safety and confidentiality of data?
11	What should be the optimum charges for an online consultation?

Survey of PO: Out of 60, 26 replied. 16 were females. Mean age was 37.1 years and 50% were in private-practice. The average experience of the respondents was 6.5 years. Eleven had started teleconsultations and 16 were aware of the regulations. Only 7 knew how to set up teleophthalmology practice. Twenty five favored the teleconsultation for non-vision threatening eye problems [Table 2]. An econsultation was preferred over video-consultation. Online-chat and telephones were not favored. The recommended fees for online consultations was 440.00 ₹. The major concerns were lack of comprehensiveness, treatment compliance, overuse and medicolegal. Twenty-five respondents wanted to practice tele-ophthalmology.

Table 2

Recommended indications for teleconsultations in pediatric ophthalmology

Recommendations by the Pediatric Ophthalmologists
Indication	Numbers (%) of respondents
For eye emergencies during the lockdown	18 (90%)
Follow-up of the patients	23 (88.5%)
For patient education	11 (42.3%)
For second opinion	10 (38.5%)
Additional recommendations
When the primary ophthalmologist was travelling.
For bed ridden patients.
For patients who live at far distance who need frequent follow ups.
Follow up of a patient with recent extraocular surgery.
For any eye emergency where local doctor is just not available.
Recommendations by the Patients
Indication	Numbers (%) of respondents
For eye emergencies during the lockdown	18 (90%)
For second opinion	7 (35%)
For patient education	3 (15%)
Follow-up of the patients	2 (10%)

Survey of patients: Out of 36, twenty replied. Twelve had video-consultations and 8 had econsultation/s. Nine patients had consulted for the first time. Mean age was 10.5 years. Mean satisfaction score was 92%. Seven desired to avail tele-consultation even after lockdown. All the patients felt helped and rated the reliability of diagnosis 88%. Eighteen recommended teleconsultation for eye emergencies during the lockdown [Table 2]. No patient was aware of government regulations. Recommended fees was 400.00₹.

The Cronbach alpha of the questionnaire for PO was 0.4, and that of the patients was 0.8. This pilot study demonstrated the need of tele-ophthalmology in pediatric eye care. Further studies with larger sample are needed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.