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Cover Focus | Jan/Feb '21

Predictions for 2020’s Influence on Ophthalmology

How will the events of the past year affect the field going forward?

Zeba A. Syed, MD

Undoubtedly, most of us will look back on 2020 as the year that fell flat on its face. Ophthalmologists had set high expectations for our field in this year of vision, but a different reality quickly set in when the world came to a standstill with the global outbreak of COVID-19. In the early months of the pandemic, we were all stunned by the recent events, we mourned the loss of members of our community, and we looked to the future with uncertainty, having no idea when life would return to a new normal. Now, almost 1 year later, a glimmer of hope has arrived as widespread vaccination efforts are under way.

Looking back at 2020, there are several ways in which its events will continue to shape ophthalmology in 2021 and beyond. Specifically, this year taught us to refine virtual education like we had never done before. At Wills Eye Hospital, we quickly transitioned our educational efforts to virtual platforms. We noticed immediately that attendance increased rapidly, and faculty members who were typically offsite during scheduled journal clubs were now able to attend virtually, allowing for a more dynamic conversation that enhanced the learning experience. We also began to conduct pathology rounds virtually, instead of from the multiheaded microscope in our pathology department. The addition of more faculty members has introduced a greater diversity of opinions and improved the event’s educational value.

I have also been involved with the Cornea Society’s virtual education efforts for fellows. Just recently, we held our first virtual Descemet membrane endothelial keratoplasty (DMEK) wet lab. Although the concept of a virtual surgical wet lab may sound counterintuitive, the experience turned out to be incredibly enriching. Fellows were provided with an artificial anterior chamber, DMEK tissue, and an adapter that mounted their smartphones to the assistant head of a surgical microscope. Instructors tuned in virtually through the assistant scopes to effectively walk fellows through the steps of DMEK. The Cornea Society has also launched virtual Journal Club and Grand Rounds initiatives, for which cornea fellows across the country gather virtually once a month to discuss pivotal research studies and challenging cases with leaders in the field. These concepts might not have been realized had the pandemic not forced us to devise innovative methods for augmenting fellow education.

Overall, 2020 has enriched virtual education in a way we never would have imagined. I look forward to reuniting with colleagues at live meetings, but I also recognize that, because of 2020, virtual education will likely remain a highly effective force in the future of ophthalmology.

Zeba A. Syed, MD
  • Co-Director, Cornea Fellowship Program, Wills Eye Hospital, Philadelphia
  • Assistant Professor of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia
  • zsyed@willseye.org
  • Financial disclosure: Bio-Tissue, Dompé

Andrés Benatti, MD

Was 2020 The Year of the Ophthalmologist? Definitely!

Undoubtedly, last year was not what we imagined it would be. At the beginning of 2020, we imagined a year full of trips, meetings, and events worldwide. Instead, we were forced to stay at home.

My fellow ophthalmologists and I have welcomed 2021 with feelings of hope and anticipation. Although we are anxious to meet again and share moments in person, I believe that 2020 will leave its mark.

Hybrid meetings are here to stay. We are receiving invitations to meetings that give us the option to participate virtually or in person. For someone like me who lives in a remote country like Argentina, far from everything, virtual meetings are becoming more and more attractive. I can no longer imagine taking one or two international trips per month, like I did in 2019, when I can participate from the comfort of my home—and attend more events than traveling would allow me.

We have witnessed how effective webinars and virtual meetings can be for our education. We learned to meet online and make the most of it. Let’s take advantage of what we have learned through virtual formats and use it to educate more students, involve colleagues from faraway places, and participate in many more events from home.

What we thought was going to drive us apart ended up bringing us closer together. Let’s continue to move forward together and learn, either in person or online!

Andres Benatti, MD
  • Cornea and refractive surgeon, Cofounder, and Chief Operating Officer, Oftalmo University, Clinica de Ojos Córdoba, Argentina
  • andresbenatti@gmail.com
  • Financial disclosure: None

Sarah H. Van Tassel, MD

I expect one of the biggest and most enduring effects of the COVID-19 pandemic to be how it reshapes ophthalmic education and continuing education. Most ophthalmologists, including me, are eager to travel and experience conferences in person again, but we have also learned how easy and powerful remote learning can be. I anticipate that future conferences will include substantial virtual offerings and more enduring materials, facilitating learning for far more people than are able to attend. This will be a game-changer for medical students, residents, and fellows, whose time and financial constraints often greatly limit their attendance at conferences. I expect the participation and engagement of international ophthalmologists to grow as well.

Virtual collaboration can also facilitate surgical teaching. A mentor can provide live feedback through a microscope video, for example. This sort of collaboration will become increasingly common. Virtual ophthalmology electives may continue as well, which would allow prospective residents to experience the cultures of multiple departments without visiting them for full electives.

None of what I have outlined is a substitute for in-person learning, but I think it’s a wonderful and meaningful supplement.

One of the biggest surprises of this pandemic has been patients’ receptiveness to virtual visits, hybrid visits, drive-through IOP checks, imaging-only visits, and other novel models of care delivery. Although virtual visits can work exceptionally well for many postoperative eyelid and strabismus appointments, as well as for some red eye evaluations and neuro-ophthalmic evaluations, for instance, it has also become clear where telehealth and nontraditional modes of care delivery fall short of the quality that patients deserve. The pandemic has highlighted a tremendous appetite among both patients and physicians for technological innovation related to eye care delivery. We ophthalmologists should feel inspired to pursue the innovation and implementation of technology for telehealth and novel care delivery in the year ahead and beyond.

Sarah H. Van Tassel, MD
  • Director, Glaucoma Service and Glaucoma Fellowship, Weill Cornell Medicine Ophthalmology, New York
  • shvantassel@gmail.com
  • Financial disclosure: None

Ivan Mac, MD, MBA

The year 2020 was supposed to be a great one for ophthalmology, but for most practices it was a disaster. We ophthalmologists endured a 6- to 8-week shutdown during the pandemic and had to weather unprecedented challenges in order to sustain our operations and come out on the other side.

In our practice, we examined all aspects of our business and ultimately continued to focus on the premium channel, as we did before. However, we realized that we need to maximize and grow the traditional insurance side of our practice as well. For 2021 and beyond, we are actively exploring joining a Clinically Integrated Network (CIN).

A CIN is a network of independent providers that uses claims data from multiple organizations to generate not only episode-of-care costs but also utilization data that are actionable and generated in nearly real time. With these aggregated data, we anticipate improving our partnering strength with payors while also benefitting financially from the value of these data.

It is our belief that value-based contracting will fundamentally change how physicians are compensated by commercial payers and Medicare. These payers are moving to risk-based, pay-for-performance contracting. Traditionally, these contracts have centered around primary care, through accountable care organizations as the vehicle for affecting quality and savings. These accountable care organizations, to which most private specialists do not have access, can generate the data to successfully compete in this environment.

Our small group practice has been unable to ascertain our true episode-of-care costs alone.

These are crucial data to have that all our payers have access to. It is important to have access to these data to confirm their accuracy, to change utilization/referral patterns if our episode-of-care costs are outliers, and to contract with payors for better reimbursement.

Specialty organizations, including the AAO, recognize the importance of generating these data, and we believe that most specialty groups will eventually endorse the CIN model. This year poses unique challenges as well as unique opportunities, and I urge others to explore them in detail.

Ivan Mac, MD, MBA
  • Founder, Metrolina Eye Associates, North Carolina
  • ivanmac@gmail.com
  • Financial disclosure: None