TOPLINE:

Among patients with idiopathic intracranial hypertension (IIH), treatment recommendations from simulated remote consults closely matched in-person clinic decisions in more than 87% of cases. However, changes in the thickness of the retinal nerve fiber layer and the presence of an enlarged blind spot were associated with a greater likelihood of discordance between two visits.

METHODOLOGY:

• Researchers conducted a prospective cohort study at a single tertiary medical center in Israel from May 2018 to October 2022 to evaluate the feasibility of an optical coherence tomography-based remote, non-encounter consult model for patients with IIH.
• They analyzed the data of 62 patients (mean age, 29.5 years; 87% women) who were followed up regularly in ophthalmology clinics.
• Treatment recommendations made during in-person clinic visits with physical examinations were compared with recommendations from simulated remote consults in which physicians reviewed only the medical history, optical coherence tomography scans of the retinal nerve fiber layer, and Humphrey visual field results without seeing the patient.
• Each simulated consult was reviewed by the same neuro‑ophthalmologist who had made the original clinic decision; only visits from at least 12 months prior were used to prevent case recognition.
• The primary outcome was the degree of agreement between clinic visit decisions and simulated remote consult decisions.

TAKEAWAY:

• The rate of agreement between treatment decisions made during clinic visits and those made during simulated remote consults was 87.1% (54 of 62 patients), with a kappa value of 0.763 (P < .001), reflecting high agreement between the two visit types.
• Patients without current medical treatment were more likely to receive the same recommendation in both visit types (P = .042).
• A change of ≥ 10 μm in retinal nerve fiber layer thickness in at least one eye was associated with disagreement between visit types (P = .044).
• The presence of an enlarged blind spot on visual field examination was associated with a greater likelihood of discordance between clinic visit and remote consult recommendations (P = .004, .048, and .001 for right eye, left eye, and both eyes, respectively).

IN PRACTICE:

“By more closely resembling in-person consultations, virtual/telemedicine visits may reduce discrepancies and improve agreement rates between clinical decisions. Additionally, given the shortage of practicing neuro-ophthalmologists, this approach is particularly valuable and necessary,” the researchers reported.

SOURCE:

The study was led by Shai Cohen, of the Faculty of Medical & Health Sciences at Tel Aviv University in Tel Aviv, Israel. It was published online on March 16, 2026, in Eye.

LIMITATIONS:

The simulated telemedicine consults were conducted via remote review so physicians could not directly question patients, hear descriptions of symptoms, or observe facial expressions and overall appearance, including weight. The study included only one visit per patient without long-term follow-up. Because the reviewed visits were chosen to be temporally distant from the study period, clinicians’ approaches may have shifted over time — becoming more or less aggressive — and this could partly explain differences between the original and simulated recommendations.

DISCLOSURES:

Tel Aviv University provided open access funding for this study. The authors reported no having relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.