Race and Age May Be Barriers to Teleophthalmology

08 December 2020, Baden-Wuerttemberg, Ludwigsburg: Ralph Brunner, senior physician in the Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy at the RKH Hospital Mühlacker, stands in front of a mobile telemedicine station in the intensive care unit of the RKH Hospital Mühlacker. On the screen he can be seen testing himself (posed scene). (to dpa: “Telemedicine lets doctors sleep more peacefully”) Photo: Sebastian Gollnow/dpa (Photo by Sebastian Gollnow/picture alliance via Getty Images)
The COVID-19 pandemic has underscored a digital divide in healthcare, a report shows.

While telemedicine has been helpful in enabling eye care, especially during the COVID-19 pandemic, certain sociodemographic groups are less likely to be able to access these services, according to a research team. An investigation shows that non-White and older patients were more likely to be seen in person for an eye care visit than to have a telemedical visit during the height of the COVID-19 pandemic. The study, published in the American Journal of Ophthalmology, explored the potential impact of this digital divide.

The University of Michigan Kellogg Eye Center in Ann Arbor, Michigan, provided in-person care only for urgent patients and deferred care or provided telemedicine-based eye care for all other patients from March 23 to May 25, 2020 following a statewide shelter-in-place order.

The researchers conducted 1720 telephone interviews with eye center patients, assessing their perception of eye health, satisfaction with care, and feeling regarding eye care or its deferral. They determined their residences’ distance from the eye center median. They identified household income and high-speed broadband internet availability based on each patient’s address’s US Census tract.

Investigators found that older patients had lower odds than younger patients of having a video visit vs a deferred visit (generalized odds ratios [gOR] = 0.85 per 10 years, 95% CI 0.75-0.96, P =.007) and higher odds of having an in-person visit vs having their visit deferred (gOR = 1.09 per 10 years, 95% CI 1.01-1.16; P =.023). The researchers point out that these older patients are the precise patients to whom COVID-19 poses a higher risk of mortality. In the whole sample, patients who had an in-person visit had a mean age of 64.7 years, while those who had a video visit had a mean age of 59.8 years.

Further distance from the eye center was associated with having any type of visit compared with a deferred visit (P ≤.054 for each comparison). Access to a broadband signal with faster download speeds was associated with lower odds of an in-person visit compared to being deferred (gOR = 0.66, 95% CI 0.46-0.94; P =.022).

Patients of minority groups also had lower odds having an in-person visit vs a deferred visit (gOR = 0.62, 0.42, 0.44, P <.02).

The study also “found a near-statistically significant association demonstrating that Black patients in the retina clinic were less likely to be seen in-person compared to being deferred than Whites,” the report says. “Black patients seen in the retina clinic should have similar levels of disease severity as White patients as requiring a similar frequency of in-person care.”

Reliable broadband access is integral to any telemedical care. But “Black and Latino Americans in the US [have] significantly less access than Whites,” the report explains. 

Similarly, “Older patients are less likely to have access to an internet connection at home or use a smartphone that can connect to the internet to participate in a video-conference based telemedicine,” according to the study. “Other barriers to video-conferencing may also exist for older adults, including a lack of comfort with technology.”

Limitations of the study included generalizability since Ann Arbor is not socio-demographically representative of the region or the country and the limited inclusion of patients living in rural areas that have less access to specialty physician services and high-quality broadband internet connection.

“To ensure that health disparities are not worsened by the heightened use of remote care, health care providers and insurance carriers must find ways to make telemedicine accessible, particularly for older Americans, racial, and ethnic minority Americans, and those with lower socioeconomic status,” the researchers say. “This may require making new modalities of telemedicine available via telephone.”


Elam AR, Sidhom D, Ugoh P, et al. Disparities in eye care utilization during the COVID-19 pandemic. Am J Ophthalmol. Published online July 25, 2021. doi:10.1016/j.ajo.2021.07.024