Importance Telemedicine has been shown to have had reduced uptake among historically marginalized populations within multiple medical specialties during the COVID-19 pandemic. An evaluation of health disparities among patients receiving ophthalmic telemedical care during the pandemic is needed.

Objective To evaluate disparities in the delivery of ophthalmic telemedicine at Massachusetts Eye and Ear (MEE) during the COVID-19 pandemic.

Design, Setting, and Participants This retrospective, cross-sectional study analyzed clinical visits at a single tertiary eye care center (MEE) from January 1 to December 31, 2020. Patients who had ophthalmology and optometry clinical visits at the MEE during the study period were included.

Exposures Telemedicine vs in-person clinical encounters.

Main Outcomes and Measures Variables associated with use of ophthalmic telemedicine during the study period.

Results A total of 2262 telemedicine ophthalmic encounters for 1911 patients were included in the analysis. The median age of the patients was 61 (interquartile range, 43-72) years, and 1179 (61.70%) were women. With regard to race and ethnicity, 87 patients (4.55%) identified as Asian; 128 (6.70%), as Black or African American; 23 (1.20%), as Hispanic or Latino; and 1455 (76.14%), as White. On multivariate analysis, factors associated with decreased receipt of telemedical care included male sex (odds ratio [OR], 0.86; 95% CI, 0.77-0.96), Black race (OR, 0.69; 95% CI, 0.56-0.86), not speaking English (OR, 0.63; 95% CI, 0.48-0.81), educational level of high school or less (OR, 0.83; 95% CI, 0.71-0.97), and age (OR per year of age, 0.99; 95% CI, 0.989-0.998). When comparing telephone- and video-based telemedicine visits, decreased participation in video-based visits was associated with age (OR per year of age, 0.96; 95% CI, 0.94-0.98), educational level of high school or less (OR, 0.54; 95% CI, 0.29-0.99), being unemployed (OR, 0.28; 95% CI, 0.12-0.68), being retired (OR, 0.22; 95% CI, 0.10-0.42), or having a disability (OR, 0.09; 95% CI, 0.04-0.23).

Conclusions and Relevance The findings of this cross-sectional study, though limited to retrospective data from a single university-based practice, suggest that historically marginalized populations were less likely to receive ophthalmic telemedical care compared with in-person care during the first year of the COVID-19 pandemic in the US. Understanding the causes of these disparities might help those who need access to virtual care.

重要性 远程医疗已被证明在 COVID-19 大流行期间减少了多个医学专业内的历史边缘化人群的吸收。需要对大流行期间接受眼科远程医疗服务的患者之间的健康差异进行评估。

目的 评估 COVID-19 大流行期间马萨诸塞州眼耳 (MEE) 提供眼科远程医疗的差异。

设计、环境和参与者 这项回顾性横断面研究分析了 2020 年 1 月 1 日至 12 月 31 日在单一三级眼科护理中心 (MEE) 的临床访问。研究期间在 MEE 进行眼科和验光临床访问的患者被包括在内。

暴露 远程医疗与面对面的临床接触。

研究期间与使用眼科远程医疗相关的主要结果和测量变量。

结果 分析中包括了 1911 名患者的总共 2262 次远程医疗眼科会诊。患者的中位年龄为 61 岁（四分位距，43-72）岁，1179 人（61.70%）为女性。在种族和民族方面，87 名患者 (4.55%) 被确定为亚洲人；128 (6.70%)，黑人或非裔美国人；23 (1.20%)，西班牙裔或拉丁裔；和 1455 (76.14%)，作为白人。在多变量分析中，与远程医疗服务减少相关的因素包括男性（优势比 [OR]，0.86；95% CI，0.77-0.96），黑人（OR，0.69；95% CI，0.56-0.86），不说英语 (OR, 0.63; 95% CI, 0.48-0.81)、高中或以下教育水平 (OR, 0.83; 95% CI, 0.71-0.97) 和年龄 (OR 每岁, 0.99; 95% CI，0.989-0.998）。在比较基于电话和视频的远程医疗就诊时，

结 _美国的 COVID-19 大流行。了解这些差异的原因可能会帮助那些需要获得虚拟护理的人。