Use of virtual care in ophthalmology in Ontario, Canada in 2020 during the COVID-19 pandemic

Objective: To investigate the use and trends of virtual care in ophthalmology and examine associated factors in a universal health care system during the COVID-19 pandemic in 2020. Design: Cross-sectional study. Participants: Ontarians eligible for the Ontario Health Insurance Plan. Methods: We used physician billing data from 2017-2020 to describe the use of virtual versus in-person care. We used logistic regression to examine factors associated with virtual care use. Results: The uptake of ophthalmic virtual visits increased immediately following the government's directive to ramp down clinic activities and institution of a new virtual fee code (17.6%), peaked 2 weeks later (55.8%), and decreased immediately after the directive was lifted (24.2%). In March-December 2020, virtual visits were higher in female (11.6%) versus male (10.3%) patients and in patients <20 years of age (16.4%) and 20-39 years of age (12.3%) versus those aged 40-64 years (10.8%) and 65+ years (10.6%). Patients residing in the poorest/poorer neighbourhoods (10.9%) had similar use as their counterparts (11.1%). Patients with an acute infectious disease (14.2%) or nonurgent diagnosis (16.2%) had the highest use. Those with retinal disease had the lowest use (4.2%). Female ophthalmologists (15.4%) provided virtual care more often than male ophthalmologists (9.9%). Ophthalmologists aged 60-69 years (13.1%) provided virtual care more often than any other age groups (<40 years: 11.3%; 40-49 years: 11.0%; 50-59 years: 10.0%; and 70+ years: 7.7%). Multiple logistic regression models revealed similar results. Conclusion: Virtual care in ophthalmology increased significantly during the initial phase of the pandemic and decreased thereafter. There were significant variations in virtual care use by patient and ophthalmologist characteristics.