Tele-Neuro-Ophthalmology During the Age of COVID-19

The coronavirus (COVID-19) pandemic continues to rapidly and dramatically transform the daily lives of patients and health care providers across the world. The number of new cases even at the time of this writing continues to grow. As individuals and as physicians, we have a responsibility to our patients and to society to"first, do no harm." As such, neuro-ophthalmologists must balance their sacred oath to "treat the sick"against the need for social distancing to help "flatten the disease curve." The American Academy of Ophthalmology (AAO), the American Academy of Neurology (AAN), the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and other public health organizations have actively updated recommendations and have suggested practices and protocols that may be of interest to practicing ophthalmologists. The AAO's early guidelines recommended that ophthalmologists defer any routine or nonurgent appointments in the clinic and postpone all elective surgical cases (see Supplemental Digital Content 1, Table E1, http://links.lww.com/WNO/A422). Thus, we have a responsibility to appropriately triage new and returning patients to ensure the safety of providers, patients, and the general public during and following this unprecedented pandemic. Neuro-ophthalmologists, however, often diagnose vision-threatening and potentially life-threatening disease, and delay in diagnosis or treatment can be devastating. Therefore, alternatives have been proposed to balance our competing interests of individual patient and provider safety from COVID-19 against the potential risk of undiagnosed or untreated neuro-ophthalmic disease