The digital footprint of Philippine eye care centres in the onset of the COVID-19 pandemic

Editor – As reported in recent articles, the pandemic has accelerated digital healthcare's rise. Following are initial teleophthalmology observations from the Philippines, a lower-middle-income archipelago whose population spends the most time online and on social media, worldwide.^1–3 Health gatekeeper mechanisms are absent, out-of-pocket financing is >50%, and population indigency is ∼30%.³ While teleophthalmology examinations and portable technology have limitations, benefits include advocacy, triage/appointment-setting and care resulting in reduction of in-person visits.^4–6

During March–June 2020, we explored website and social media presence/footprints of eyecare centres: 135 private ambulatory surgicentres (ASCs) and 27 tertiary centres with training programmes (TCs). Findings include:

• majority having websites (88% ASCs; 54% TCs) and being present on Facebook (83%–100%)

• a low presence on other top social media platforms; lowest in Instagram (25% TCs)

• COVID-related material (81% TCs) and telemedicine services (20% ASCs; 50% TCs) are posted mostly on Facebook

• eye/ophthalmic health content present in up to 37% of sites.

We excluded existing telemedicine platforms (eg National Telehealth Center serving distant municipal/rural health facilities and private establishments / health insurance companies serving ∼2.3% of the population) and personal professional websites/social media pages.

The telemedicine landscape is largely unexplored, and we found that ophthalmic care providers are populating the space. Further, online platforms were used for pandemic-era issues: tributes to healthcare workers that have died, advocacy for preventive eye care given overwhelmed healthcare systems etc. For individual providers, a recent survey noted similar trends/perspectives seen elsewhere including increasing/majority openness to teleophthalmology, use of modalities other than telephone, increasing use for new patients and decreased confidence in applicability to certain diseases and clinical circumstances.⁷

As elsewhere, we lack insight into population perspectives and outcomes. Impact of provider choice, patient journey, accessibility and improved ophthalmic outcomes are unknown. Negative impacts of content (occasional sparse and dated information), risk for harm/falsehood cannot be excluded.

Telemedicine's potential strengths include convenience and safety. Though currently with inadequacies, its relevance likely will grow in a disrupted, innovating post-COVID world. It bears potential to leapfrog challenges, particularly in the developing world and gatekeeper-free systems. It is an area of future healthcare that must be examined continually.