Commentary: Teleophthalmology in India: Hybrid approach will be a game changer in the COVID-19 Era.

Teleophthalmology is a promising and innovative technology to modernise the existing eyecare facilities. It has immense utility in achieving the dream of equitable and accessible healthcare for everyone as it has enormous potential to serve the most underserved population and those living in far remote areas. India is a country which has a varied geography and demography where 70% of people reside in rural areas and majority of the ophthalmologists practice in the urban areas. It can range from discussion of two doctors over phone to a complex patient–doctor interface/application.

This article has highlighted the feasibility and initial experiences of using teleconsultation to manage patients during the COVID-19 pandemic.[1] This pandemic has forced many of the industries to shift to remote operations. Patients are also cautious to go to hospitals due to the fear of acquiring the disease. This has resulted in reduced footfall of patients and adoption of new measures to continue clinical practice.[23] Here, teleophthalmology can also play an important role in retaining the patients, continuing the operations and maintaining financial health of the hospitals.

It is very important to define the scope of teleophthalmology which may be varied depending on the clinical settings and resources like patient reassurance, assessing drug compliance, follow-up/postoperative care, etc. Oculoplasty can benefit more than other subspecialties.[4] It can also help in screening of various diseases such as diabetic retinopathy, age-related macular degeneration, retinopathy of prematurity, and glaucoma.[5]

Hybrid approach involves merging the teleophthalmology solutions into the existing multitier pyramidal health-care system where these solutions can supplement and potentiate the benefits of our existing eyecare services. It can help in decreasing the burden of the existing system. Various subspecialties have envisaged a model where diagnosis, preoperative planning and postoperative follow-ups can be planned remotely and the patient need to come to the health-care facility only for the actual surgery/procedure.[6] This time-saving and resource-friendly approach is particularly beneficial for the patients. This approach offers improved satisfaction among the patients due to increased accessibility and reduced travelling time and cost.[7]

There is a strong need to develop standardised teleophthalmology solutions and comprehensive standard operating procedures which are user-friendly, economical and patient-friendly. Special impetus should be provided by the central and state governments to develop smarter solutions which cater to the specific needs of the locals. Efforts must be initiated to raise the awareness in general public about the benefits of teleophthalmology. Studies have shown that an aware patient population is more receptive and motivated to implement the solutions offered by teleconsultation.[7] Unaware patients also have a tendency to pay less for the services. Special training and orientation sessions must be arranged for the general ophthalmologists and trainee residents by incorporating it in their training curriculums.[8910] Physicians fear about the accuracy of these platforms and also the need for high investment and training.[11] Lack of well-defined legal framework is also another barrier in India which demotivates the doctors to practise teleophthalmology over fears of malpractice.[11] Recently, the Indian Medical Council and NITI Aayog have made initial efforts to streamline its application in India.

Digital health will be revolutionising healthcare delivery just like the advent of computers or smartphones ushered a new era. There is a strong need to adapt with the changing technology and start adopting it. Merging artificial intelligence technology with teleophthalmology can have innumerable benefits and fruitful outcomes if various concerns of patients and doctors are adequately addressed.[12]