| OCR Text |
Show Technology in Neuro-Ophthalmology Practical Approach to the Tele-Neuro-Ophthalmology and Neuro-Otology Visits: Instructional Videos Rachel Calix, MBBS, Scott N. Grossman, MD, Nailyn Rasool, MD, Leslie Small, OD, Catherine Cho, MD, Steven L. Galetta, MD, Laura J. Balcer, MD, MSCE, Janet C. Rucker, MD Downloaded from http://journals.lww.com/jneuro-ophthalmology by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 05/04/2022 Abstract: A collection of instructional videos that illustrate a step by step approach to tele-neuro-ophthalmology and neuro-otology visits. These videos provide instruction for patient preparation for their video visit, patient and provider interface with an electronic medical record associated video platform, digital applications to assist with vision testing, and practical advice for detailed remote neuroophthalmologic and neuro-otologic examinations. experience, including technologies specific to the institution. He also comments on specific examination maneuvers, such as confrontation visual field, that are performed remotely in the context of a tele-neuro-ophthalmology examination (See Supplemental Digital Content, Video 1, http://links.lww.com/WNO/A453). Journal of Neuro-Ophthalmology 2021;41:10–12 doi: 10.1097/WNO.0000000000001195 © 2021 by North American Neuro-Ophthalmology Society VIDEO 2: DOWNLOADING EYE HANDBOOK (SCOTT GROSSMAN) VIDEO 1: INTRODUCTION TO PRACTICAL TELE-NEURO-OPHTHALMOLOGY AND OTOLOGY VIDEOS (STEVEN GALETTA) This segment demonstrates the process for downloading the free Eye Handbook application on iOS, which may be helpful for patients. This video includes negotiating the search function in the App Store, the appearance of the Eye Handbook app icon, agreement to app consent, continuing without login option, and accessing the testing portion of the application. Prompts and pop ups within the application are also addressed (See Supplemental Digital Content, Video 2, http://links.lww.com/WNO/A454). Dr. Steven Galetta offers an introduction for the group of instructional videos in this online resource for neuroophthalmologists. He specifies that videos were made during the height of the COVID-19 outbreak in New York City under conditions of social distancing and that the videos are centered on the NYU neuro-ophthalmology Department of Neurology (RC, SNG, CC, SLG, LJB, JCR), New York University Grossman School of Medicine, New York, New York; Department of Ophthalmology (NR, LS), University of California San Francisco, San Francisco, California; Departments of Ophthalmology (SLG, LJB, JCR) and Population Health (LJB), New York University Grossman School of Medicine, New York, New York. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text and PDF versions of this article on the journal’s Web site (www. jneuro-ophthalmology.com). Address correspondence to Scott N. Grossman, MD, Department of Neurology, NYU Grossman School of Medicine, 222 East 41st Street, 14th Floor, New York, NY 10017; E-mail: scott.grossman@ nyulangone.org 10 VIDEO 3: PATIENT LOGGING ON TO VISIT (LAURA BALCER) This video demonstrates the process of logging on to a video visit on the Epic telemedicine platform from the patient’s perspective. A clear view of the electronic device is presented to illustrate the necessary steps for completing online documentation and connecting to the provider. It identifies the MyChart Application online portal icon, items such as confirmation of insurance and questionnaires which require completion within the application, and the appearance of being in the “virtual waiting room.” This segment ends at the point which the provider would join the visit. Many other institutions and telemedicine platforms have different approaches to logging on to the visit, including directly contacting the patient or physician over 2-way audio– visual connection (See Supplemental Digital Content, Video 3, http://links.lww.com/WNO/A455). Calix et al: J Neuro-Ophthalmol 2021; 41: 10-12 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Technology in Neuro-Ophthalmology VIDEO 4: PHYSICIAN CONNECTING AND CONDUCTING VISIT (LAURA BALCER AND STEVEN GALETTA) This video demonstrates the process by which the provider initiates and conducts a tele-neuro-ophthalmology visit on the Epic platform, with attention to workflow from the Epic desktop to Haiku on an iPhone. In addition to the demonstrated option of initiating the visit by passing the visit off from a desktop PC Epic connection to the iPhone, a visit can also be directly initiated on the iPhone itself. Similar options exist for the iPad with connection through an application called Canto. This video also demonstrates practical aspects of the patient examination, including an illustration of how to instruct the patient to use a flashlight for pupillary assessment and how to evaluate central visual fields. Positioning of the screen is essential for maximizing yield of the remote tele-neuro-ophthalmology examination. Capturing both eyes is typically optimal in “landscape” orientation, whereas the device may need to be placed in “portrait” orientation for capturing the peripheral neurologic examination or gait examination. The participants demonstrate the portions of the general neurologic examination which can be tested remotely. During filming, we experienced a connectivity issue, and this opportunity allowed us to demonstrate how to troubleshoot technical difficulties encountered within a video visit which can frequently arise. Institutions other than NYU may use electronic medical records other than Epic, and each telemedicine platform may have different methods of connecting various remote devices (Link: https://nyulangone-my. sharepoint.com/:v:/g/personal/scott_grossman_nyulangone_ org/ETEiZg7IBJtPhussBEfZPb8B63Ek6tPu3B57k9vwFJi Lbg?e=60uTXj). VIDEO 5: VISION TESTING OPTIONS (RACHEL CALIX AND JANET RUCKER) This video focuses on approaches to examination of the afferent visual system during a tele-neuro-ophthalmology visit. Strategies presented include implementation of a patient-printed near visual acuity card, Snellen distance visual acuity poster, and an Amsler grid. Options for patient occlusion of 1 eye are demonstrated including with the palm of their hand, a spoon, driver’s license, or with a tissue occluding 1 lens of their glasses. Use of the various features of the Eye Handbook (1) application for iPhone is also demonstrated. These include near visual acuity testing, Ishihara color plates, and “red screen bilateral” for evaluation of red desaturation. The use of the website www.farsight. care is also highlighted—this site allows evaluation of near visual acuity including calibration of the size of the illustration with a credit card, an Amsler grid, and red swatch. The use of Ishihara color plates displayed through the device camera is demonstrated Calix et al: J Neuro-Ophthalmol 2021; 41: 10-12 if the patient does not have access to the Eye Handbook application (Link: https://nyulangone-my.sharepoint.com/:v:/g/ personal/scott_grossman_nyulangone_org/Ef5Fz1edo-VFv5iI Wkcn1XYBrNT2OsCSlFjDouyiryruaA?e=qUs9b1). VIDEO 6: DETAILED OCULAR MOTOR, VESTIBULAR, AND CEREBELLAR EXAMINATION (CATHERINE CHO AND SCOTT GROSSMAN) The targeted ocular motor, vestibular, and cerebellar examination is necessary for localizing lesions that result in patient complaints of unsteadiness, room-spinning, or visual phenomena such as oscillopsia. Here, we depict an examination approach for ocular motor or vestibular complaints. It is necessary to have space and flexibility of camera positioning for performing this examination, especially because physicians need to be able to visualize the entire body of the patient. We demonstrate focused vestibular components of the examination, including targeted examination of eye movements, supine/seated testing for positional nystagmus, and vestibular functional testing using a monocular bright flashlight as an alternative to the Frenzel examination that cannot be confirmed remotely (Link: https://nyulangone-my.sharepoint.com/:v:/g/ personal/scott_grossman_nyulangone_org/EdMQCCSwaO 1Kq0vasUiiuEABaRRn9hhUNACxp7GnqakuTA?e=OkQ T5U.) (2). VIDEO 7: VISUAL FIELD INSTRUCTIONAL VIDEO (NAILYN RASOOL AND LESLIE SMALL) This video illustrates how to perform visual acuity and visual field testing on the platform EyeSimplify (3). EyeSimplify is a methodology for remotely assessing visual fields over a 2-way audio–visual connection that includes a portable threshold testing of visual field for patients with conditions including glaucoma or neuroophthalmic disorders. It is available for purchase by contacting its manufacturer and provides online platforms for reviewing studies that patients complete at home. Suggestions for completing the visual field include having the necessary items available for assistance with calibration and testing. Items needed include a ruler, credit card, tape, and tissue paper. The video demonstrates, from a patient’s perspective, how to ensure the proper environment for testing, including dim ambient lighting, bright computer screen, and appropriate patient positioning. Within EyeSimplify, calibration, visual acuity testing, and visual field testing are shown, and patient instructions are emphasized (See 11 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Technology in Neuro-Ophthalmology Supplemental Digital Content, Video 7, http://links. lww.com/WNO/A458). REFERENCES 1. Tofigh S, Shortridge E, Elkeeb A, Godley BF. Effectiveness of a smartphone application for testing near visual acuity. Eye (Lond). 2015;29:1464–1468. 12 2. Newman-Toker DE, Sharma P, Chowdhury M, Clemons TM, Zee DS, Della Santina CC. Penlight-cover test: a new bedside method to unmask nystagmus. J Neurol Neurosurg Psychiatry. 2009;80:900–903. 3. Prea SM, Kong YXG, Mehta A, He M, Crowston JG, Gupta V, Martin KR, Vingrys AJ. Six-month longitudinal comparison of a portable tablet perimeter with the humphrey field analyzer. Am J Ophthalmol. 2018;190: 9–16. Calix et al: J Neuro-Ophthalmol 2021; 41: 10-12 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
