Limitations of Telemedicine Vs. Face-to-face Eye Examination in a Patient with New Headaches

Abstract

Background: During the emergence and rise of COVID-19, precaution directives and limitations on in-person eye examinations re-routed a significant portion of care to telemedicine and virtual modalities. While these technologies allowed for healthcare communications that otherwise could not occur during such trying times, there are major limitations to these sanctioned applications. This report will present a seemingly benign case that could have easily been re-routed from an in-person examination to a telemedicine version due to the patient’s seemingly “routine” vision complaints. Case Report: A 50-year-old male patient contacted the eye clinic with a complaint of a minor, new, unexplained headache that he felt may have been related to a change in his vision. The patient requested a telehealth examination with the eye clinic to avoid exposure to COVID-19. After due consideration, the optometry clinic recommended an in-person eye examination despite the very heavy limitations requiring “emergency only” patients in the hospital. On examination it became evident that the cause of the headaches was a rebound hypertensive crisis and the patient did require emergency medical services to stabilize his condition. Conclusion: This case was ultimately a serious emergency that would have been missed via a remote evaluation. The patient was fortunate to have been given a face-to-face appointment during a time of heavy restrictions and essentially emergency-only appointments. This should serve as a reminder to all eye care practitioners that new headaches are a symptom requiring an in-person evaluation, should a future event require similar clinical limitations. Despite the rarity, even a light headache in an early presbyope, as seen in this case, could be the only overt sign of an emergent condition.