Ophthalmologists urge video consultation standards before telemedicine law takes effect

With four months left before a revised Medical Service Act allowing telemedicine takes effect, ophthalmologists say detailed standards for diseases requiring visual information are still lacking.

They are calling for follow-up rules to be finalized quickly, including requirements for video consultations and clear criteria for switching patients to in-person care, to ensure the safety of those with eye conditions.

The Korean Ophthalmologists Association (KOA) held a press briefing on Tuesday, urging the government to establish specific patient safety standards before the law takes effect.

The revised Medical Service Act, scheduled to take effect Dec. 24, requires video communication for telemedicine when visual information is essential. It delegates to an ordinance of the Ministry of Health and Welfare the task of specifying which diseases fall into that category and how video consultations should be conducted.

The KOA stressed that most eye diseases are difficult to diagnose based solely on patients' reported symptoms. Diagnosis and treatment decisions generally require a combination of objective test results, including visual acuity and intraocular pressure measurements, slit-lamp examinations, fundus examinations, visual field tests and optical coherence tomography (OCT).

Oh Chung-hoon, chairman of the Korean Ophthalmologists Association’s Medical Policy Committee, says eye diseases should be clearly designated as conditions requiring visual information in telemedicine. (KBR photo)

"Eye diseases should be clearly designated as conditions requiring visual information, with video consultation established as the basic principle," said Oh Chung-hoon, chairman of the KOA's Medical Policy Committee. "Real-time, two-way video communication should be the standard for telemedicine.

Switching to in-person care is key to safe ophthalmic telemedicine

The association also called for detailed criteria specifying when a telemedicine consultation should be discontinued and when the patient should be referred for in-person care or emergency evaluation.

It said such criteria are necessary because even when no obvious abnormality is visible on video, certain symptoms or warning signs may indicate a sight-threatening condition requiring an in-person examination or emergency evaluation.

The KOA proposed several situations warranting in-person care or emergency evaluation, including acute vision loss or a sudden change in vision occurring within 24 hours; flashes of light, a sudden increase in floaters, visual field defects or a curtain-like shadow over the field of vision; severe eye pain or bleeding accompanied by pain; chemical exposure or trauma to the eye or orbit; pain, vision loss, severe bleeding or discharge occurring within four weeks after eye surgery; and newly developed double vision, drooping eyelids or neurological symptoms.

"What can be seen through an ordinary smartphone or computer video call is largely limited to images of the external eye," Oh said. "The absence of visible abnormalities on a video screen does not rule out a sight-threatening disease."

He added that even in the absence of clear emergency symptoms, patients should be switched to in-person care if they are infants or young children, have difficulty communicating, if video quality is inadequate, or if a healthcare professional determines that a specialized ophthalmic examination is necessary.

"This is a critical procedure for patient safety," Oh said.

Video requirement alone not enough; minimum technical standards needed

The KOA said simply requiring video communication would not be sufficient. Minimum technical standards should also be established to ensure that image quality is adequate for assessing eye conditions, thereby clarifying the policy requirements.

The association proposed real-time, two-way video communication as the baseline, with the ability to verify both the patient's identity and the area being examined. It also suggested minimum requirements, including autofocus for close-up imaging, sufficient resolution for clinical interpretation, adequate and uniform lighting, and stable video transmission.

"Even during video consultations, the patient's identity must be verified in real time, and the video must clearly show the area being examined," Oh said. "Minimum standards should require cameras capable not only of ordinary video but also autofocus and close-up imaging."

"What matters is not simply having an image, but having an image of sufficient quality for clinical interpretation," he added. "Such requirements have not yet been established, and we are asking that they be reflected in the enforcement rules."

The ophthalmology community has not proposed specific requirements for camera performance or resolution. Rather, it is calling on the government and medical community to agree on minimum technical standards during the remaining months before the law takes effect.

"Our concern is that regulations like these are necessary for telemedicine, yet there has not even been a discussion about them," Oh said. "The law is due to take effect on Dec. 24. In other countries, standards such as camera requirements are established before implementation. We are asking the government to begin discussing those standards."

"For example, full HD quality, as displayed on a computer monitor, may be an appropriate minimum," he said. "How much close-up capability a camera should provide will need further discussion. This is not an issue limited to ophthalmology; dermatology may also require close-up imaging.

Oh stressed that the association is not seeking to restrict telemedicine itself.

"What we are asking for is an institutional framework that allows eye diseases to be treated safely through telemedicine," he said. "In ophthalmology, even a single delay in diagnosis can lead to irreversible vision loss, so patient safety standards, including video quality requirements and clear criteria for switching to in-person care, need to be spelled out."