To determine whether virtual neuro-ophthalmology visits satisfy patients' needs and provide physicians with adequate clinical information for decision-making.

The novel coronavirus 2019 (COVID-19) pandemic has transformed healthcare. With the need to limit COVID-19 exposures, telemedicine has become an increasingly important format for clinical care. Neuro-ophthalmology faces unique challenges given its dependence on the physical examination. The purpose of this study is to analyze both neuro-ophthalmology physician and patient satisfaction with virtual visits during the time of the COVID-19 pandemic.

Telemedicine surveys were administered to 159 patients, and neuro-ophthalmology providers completed 90 surveys. The patient survey consisted of five questions regarding preparation, satisfaction, challenges, and comfort. The provider survey comprised four questions focused on ability to gather clinical information.

Among 159 patients, 104 (65%) were satisfied with the visit, and 149 (94%) felt comfortable asking questions. 74% (68/92) of patients found the instructions easy to understand. Potential areas of improvement included more detailed preparation instructions and better technology (phone positioning, internet connection, and software). Over 80% (45/55) of surveys completed by neuro-ophthalmologists reported conducting an examination that provided enough information for decision-making. Some areas of the neuro-ophthalmologic exam were easy to conduct (range of eye movements, visual acuity, Ishihara color plates, Amsler grids, and red desaturation). Other components proved more difficult (pupil exam, saccades, convergence, oscillations, and smooth pursuit); some were especially challenging (ocular alignment, visual fields, vestibulo-ocular reflex [VOR], VOR suppression, and opto-kinetic nystagmus). Clinicians noted that virtual exams were limited by patient preparation, inability to perform certain parts of the exam (funduscopic and pupillary exams), and technological issues.