Patient Demographics, Vision Impairment Can Hinder Telehealth Use

Telemedicine female general practitioner (GP) explains to a geriatric patient the importance of determining a field of view (FOV).
Researchers say that telehealth, although necessary during the COVID-19 pandemic, may introduce unintentional disparities based on age, race/ethnicity, and socioeconomic status.

Clinicians across the board, ophthalmologists included, are encouraged to offer telehealth services due to the COVID-19 pandemic. While the internet may offer a new pathway to care, inexperience with technology can be a barrier for some patients, a study published in JAMA Ophthalmology says. 

Investigators say their research found significant differences in experience using the internet for health care based on age, race/ethnicity, and socioeconomic status.

The investigators gathered data through the National Health Interview Survey (NHIS) from between 2016 and 2017. All study participants (3667 total) self-reported a diagnosis of macular degeneration, diabetic retinopathy, or other common chronic eye diseases that required ongoing clinical care. A majority of participants were female (57.3%) and the average age was 67.2. 

Out of the 3667 participants, 846 of them have used the internet for health care activities in the 12 months prior to their interview.

Using the internet is defined by the investigators as “self-reported use of at least 1 of 5 online health care practices (‘looking up health information,’ ‘requesting a prescription medication,’ ‘scheduling a medical appointment,’ ‘communicating with a health care provider,’ and ‘using online groups to learn about health topics’) .

The investigators identified that participants who were less likely to use to the internet were older than 85 years old (83 [15.8%] of those >85 years of age vs 107 [79.3%] of those 18-39 years of age, P <.001), Black (166 [39.1%]of Black participants vs 1308 [48.4%] of Caucasian participants, P =.01), Hispanic (90 [36.6%] of Hispanic participants vs 1480 [48.9%] of non-Hispanic participants, P =.006) and had lower levels of education (90 [15.7%] of those with no high school diploma vs 624 [69.9%] of college graduates, P <.001). 

Also, patients with eye diseases may have decreased vision, which can make using the internet more difficult, the researchers noted. 

The study authors suggest that ophthalmologists should give more attention to patients who are older; identify within a racial or ethnic minority; have obtained less education; and have a low household income. 

Also, the research points out that the Centers for Medicare and Medicaid Services’ current reimbursement policies for telephone and internet-based care may help reduce the disparities shown in the data. Increased access to broadband internet would also help improve equity in telehealth.


Stagg B,  Gupta D, Ehrlich J,. Evaluation for disparities in experience with internet-based health care among US patients with chronic eye diseases. JAMA Ophthalmol. Published online August 27, 2020. doi:10.1001/jamaophthalmol.2020.3016