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Browsing by Author "Rucker, Janet C."
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Item Tele-Neuro-Ophthalmology During the Age of COVID-19(Wolters Kluwer, 2020-09) Lai, Kevin E.; Ko, Melissa W.; Rucker, Janet C.; Odel, Jeffrey G.; Sun, Linus D.; Winges, Kimberly M.; Ghosh, Arko; Bindiganavile, Shruthi Harish; Bhat, Nita; Wendt, Sydney P.; Scharf, Jackson M.; Dinkin, Marc J.; Rasool, Nailyn; Galetta, Steven L.; Lee, Andrew G.; Ophthalmology, School of MedicineIn this article, we present possible “best practices” for neuro-ophthalmologists to design and implement tele-neuro-ophthalmology during and following this national and international crisis. We review the previsit, intravisit, and postvisit steps in a practical manner that we hope will be of value to practicing neuro-ophthalmologists. We include sections on how to appropriately implement telemedicine and patient selection, focusing on different types of visits, determining eligible patients, and triaging patients. In addition, we outline the software and hardware requirements for the electronic medical record (EMR), including Epic and non-Epic platforms. We also describe the nuts and bolts of how to get started, including descriptions of the multiple useful applications and software available. As with any medical encounter, privacy regulations, billing, and coding can be significant hurdles to implementation, and we discuss each in detail. We hope that this article will be of use for neuro-ophthalmologists, comprehensive ophthalmologists, and general neurologists because we deal with effects and aftereffects of this COVID-19 pandemic. We believe that this current disruptive innovation will drive the future of telemedicine in neuro-ophthalmology.Item Telemedicine Evaluations in Neuro-Ophthalmology During the COVID19 Pandemic: Patient and Physician Surveys(Wolters Kluwer, 2021-09) Conway, Jenna; Krieger, Penina; Hasanaj, Lisena; Sun, Linus; Scharf, Jackson M.; Odel, Jeffrey G.; Dinkin, Marc J.; Oliveira, Cristiano; Mackay, Devin D.; Rasool, Nailyn; Ko, Melissa W.; Rucker, Janet C.; Galetta, Steven L.; Balcer, Laura J.; Neurology, School of MedicineBackground: The novel coronavirus 2019 (COVID-19) pandemic has transformed healthcare. With the need to limit COVID-19 exposures, telemedicine has become an increasingly important format for clinical care. Compared to other fields, neuro-ophthalmology faces unique challenges given its dependence on physical examination signs that are difficult to elicit outside the office setting. As such, it is imperative to understand both patient and provider experiences in order to continue to adapt the technology and tailor its application. The purpose of this study is to analyze both neuro-ophthalmology physician and patient satisfaction with virtual health visits during the time of the COVID-19 pandemic. Methods: Across three institutions (NYU Langone Health, Indiana University Health, and Columbia University Medical Center), telemedicine surveys were administered to 159 patients. Neuro-ophthalmologists completed 157 surveys; each of these were linked to a single patient visit. Patient surveys consisted of five questions regarding visit preparation, satisfaction, challenges, and comfort. The physician survey included four questions that focused on ability to gather specific clinical information by history and examination. Results: Among 159 patients, 104 (65.4%) reported that they were satisfied with the visit, and 149 (93.7%) indicated that they were comfortable asking questions. Sixty-eight (73.9%) patients found the instructions provided prior to the visit easy to understand. Potential areas for improvement noted by patients included more detailed preparation instructions and better technology (phone positioning, internet connection, software). Over 87% (137/157) of neuroophthalmologists surveyed reported having performed an examination that provided enough information for medical decision-making. Some areas of the neuro-ophthalmologic exam were reported to be easy to conduct (range of eye movements, visual acuity, Amsler grids, Ishihara color plates, and pupillary exam). Other components were more difficult (saccades, red desaturation, visual fields, convergence, oscillations, ocular alignment, and smooth pursuit); some were especially challenging (vestibulo-ocular reflex [VOR], VOR suppression, and optokinetic nystagmus). Clinicians noted that virtual health visits were limited by patient preparation, inability to perform certain parts of the examination (funduscopy and pupils), and technological issues. Conclusions: Among virtual neuro-ophthalmology visits evaluated, most offer patients with appointments that satisfy their needs. The majority of physicians in this cohort obtained adequate clinical information for decision-making. Even better technology and instructions may help improve aspects of virtual health visits.