Teleophthalmology techniques increase ophthalmic examination distance

In response to 'Quantifying examination distance in ophthalmic assessments.' [1] We read the above correspondence with interest. In ophthalmic care, proximity to the patient is often necessary. In cases where patients are non-mobile, bedside reviews may bring the ophthalmologist even closer, particularly if a portable slit lamp or direct ophthalmoscopy is required. Moreover, in the Coronovirus disease 2019 (COVID-19) pandemic, PPE including a face shield makes biomicroscopic slit lamp examination difficult as there is a physical barrier between the examiner and the oculars. The proximity required may put the ophthalmologist at increased risk of acquiring COVID-19. [2] Social distancing has become a key concept to reduce the spread of COVID-19, with the WHO recommending keeping a 1m distance to others. Teleophthalmology has seen an increased role in service delivery in Scotland. [3] Whilst telemedicine is being used in service redesign, the added benefit with regards to COVID-19 is the increased proximity it affords during examination. Furthermore, by replacing eye-to-eye direct line-of-sight with a digital image, recording or casting visualised signs is straightforward. This allows scrubbing of video to find relevant clinical signs. In the case of paediatric imaging where interpretation is frequently based on a fleeting glimpse, the examiner can now rewind and focus on relevant frames, theoretically gleaning more information from a shorter exam. In addition, where second opinions are required from senior colleagues, the facility to record may reduce the necessity for re-examination by others, further minimising clinician-patient contacts