Paper Title
Tele-Ophthalmology in Covid Era- A New Chapter

Abstract
Background: The Coronavirus (COVID-19) outbreak has rapidly emerged to be a global health threat. Infection control measures and social distancing has proven to be the only way out to limit the contagion. Ocular secretions have proven to be a portal of entry and source of the virus. It is in this context, that tele-consultation is evolving into an integral clinical tool to offer remote eye care. In this study we describe our experience with tele-ophthalmology in the ongoing lockdown. Aim: To describe the clinical spectrum of patients seeking tele-ophthalmology consultation in a government tertiary health carecentre and to understand the role of Tele-ophthalmology in diagnosing and treating ocular conditions during COVID lockdown. Materials and Methods: This is a cross sectional, observational study conducted over 3 months. Demographics, history and clinical data of patients who consulted over Tele-ophthalmology services using WhatsApp on Tele-ophthalmology mobile phone or eSanjeevani, a Government of India medical consultation portal from 1st May 2020 to 31st July 2020 was analyzed. Result: During the span of 3 months of lockdown, a total of 181 patients (male,116 [64.09%]; 65 females[35.91%]) with mean(±SD) age of 44.05(±22.75) years sought consultation through tele-consultation. Among them, 123(67.96%), patients were old follow up cases and 58 (32.04%) were new. One hundred and eight (59.67%) patients hailed from urban areas while 73 (40.33%) were from semi urban or rural areas.. Majority of the patients were diagnosed with conjunctivitis(allergic/infective=68),dry eye(8) and treatment was given over telephonic conversation. Most of the complaints were redness/watering/itching and asthenopic symptoms. Ocular Itching and foreign body sensation was more likely to occur among patients in urban area with an odds ratio of 1.17 and 1.87 respectively at 95% confidence level. Eye strain was also more common in urban patients in our study with an odds ratio of 1.24.Routine follow up patients of the ophthalmology sub-speciality clinics namely glaucoma(28), cornea(13), retina(17),uveitis(2) were given follow up advices after review of previous medical records sent by patients on the hospital’s cross platform messaging technology. After triage, 94% of patients could be managed with tele-consultation alone while 6% patients required hospital emergency visit for further treatment. Conclusion: COVID-19 pandemic and the accompanying social distancing policies are tremendously impacting the health care delivery.Tele-ophthalmology consultation can help in appropriate patient triage and address minor ocular ailments in this crisis. Keywords - COVID-19,Teleconsultation, Teleophthalmology, Novel Coronavirus, Health Care