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Overcoming barriers of retinal care delivery during a pandemic—attitudes and drivers for the implementation of digital health: a global expert survey
  1. Livia Faes1,2,
  2. Amir Rosenblatt3,
  3. Roy Schwartz1,
  4. Sara Touhami4,
  5. Camila V Ventura5,6,
  6. Irini P Chatziralli7,
  7. Jorge Ruiz-Medrano8,
  8. Denise Vogt9,
  9. Alfonso Savastano10,
  10. Humberto Ruiz-Garcia11,
  11. Dominika Pohlmann12,
  12. Anat Loewenstein3
  13. on behalf of the International Retinal Collaborative
  1. 1 Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
  2. 2 Eye Clinic of the Cantonal Hospital of Lucerne, Lucerne, Switzerland
  3. 3 Division of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
  4. 4 Department of Ophthalmology, Pitié Salpètriére University Hospital, Sorbonne Université, Paris, France
  5. 5 Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
  6. 6 Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
  7. 7 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
  8. 8 Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
  9. 9 Department of Ophthalmology, Ludwig-Maximilians-University Munich, Germany
  10. 10 Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  11. 11 Clinica Oftalmológica Santa Lucía, Guadalajara, Mexico
  12. 12 Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  1. Correspondence to Anat Loewenstein, Division of Ophthalmology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Weizmann St 6, Tel Aviv-Yafo, Israel; anatl{at}


Background/Aims The SARS-CoV-2 pandemic has imposed barriers to retinal care delivery worldwide. In this context, retinal services are exploring novel ways to ensure access to healthcare.

Methods We conducted a worldwide survey among retinal specialists between March 31, 2020 and April 12, 2020. The expert survey was developed on the basis of focus group discussions involving retinal specialists and literature searches. It included 44 questions on alternative ways of care provision including digital health domains such as teleophthalmology, home monitoring or decentralised patient care.

Results 214 retinal experts participated in the survey, of which 120 (56.1%) had more than 15 years of experience in ophthalmology. Most participants were clinicians (n=158, 73.9%) practising in Western Europe (n=159, 74%). In the majority of institutions, teleophthalmology, home monitoring and decentralised patient care have not been implemented before the pandemic (n=46, 21.8.1%; n=64, 29.9%; n=38, 19.1%). During the pandemic, the use of teleophthalmology and home monitoring increased significantly (n=105, p<0.001; n=90, p<0.001). In the subgroup of institutions reporting no teleophthalmology service before and implementing a service during the pandemic (34/70, 48.6%), reimbursement was the sole significant parameter (OR 9.62 (95% CI 2.42 to 38.16); p<0.001).

Conclusion Digital health is taking the centre stage tackling unpreceded challenges of retinal care delivery during the SARS-CoV-2 pandemic and may sustainably change the way we practice ophthalmology.

  • Retina
  • Telemedicine

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  • Twitter Roy Schwartz@royschwartz.

  • Contributors All authors contributed to the conception and design of the study and the administration of the survey. LF conducted data analyses. All authors contributed to the interpretation of the data and the writing of the manuscript. All authors reviewed the manuscript and contributed to its revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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