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Virtual visits (VVs) are necessitated due to the public health crisis and social distancing mandates due to COVID-19. However, these have been rare in ophthalmology. Over 3.5 years of conducting >350 ophthalmological VVs, our group has gained numerous insights into best practices. This communication shares these experiences with the medical community to support patient care during this difficult time and beyond. We highlight that mastering the technological platform of choice, optimizing lighting, camera positioning, and "eye contact," being thoughtful and creative with the virtual eye examination, and ensuring good documenting and billing will make a successful and efficient VV. Moreover, we think these ideas will stimulate further VV creativity and expertise to be developed in ophthalmology and across medicine. This approach, holds promise for increasing its adoption after the crisis has passed.

Background: ACL graft tears and contralateral injuries are problematic in pediatric sports medicine, with a combined incidence of 25-35%. Recent publications have highlighted a high failure rate with hamstring autografts in young patients, while others have suggested lower failure rates with quadriceps autografts. However, little is known about the possible reasons for this difference. Hypothesis: We hypothesized that the use of quadriceps soft tissue autografts would lessen post-operative neuromuscular deficits compared to other autografts, and therefore, young athletes would achieve objective return to sport (RTS) criteria more rapidly. Methods: A retrospective review of consecutive patients who underwent ACL reconstruction by a single surgeon and completed a comprehensive series of physical performance tests (PPTs) at 6 months post-surgery was conducted. A chart review of demographic and surgical data was completed. Patients performed nine common PPTs; limb symmetry index (LSI) was established and LSI> 90% was used as the cut-off for passing each individual test. Athletes met RTS criteria if they achieved LSI>90% on at least 8 of 9 tests. Multivariate linear and logistic regressions were performed to assess the effect of age (dichotomous; pediatric (Results: The cohort of 68 young, active patients (mean age= 18.9 years +/- 7.5; 56% pediatric; 46% female; graft type: 63% BTB, 16% hamstring, 15% quadriceps, 6% ITB) were tested at a mean 6.7 months +/- 1.9. Overall, 35% of patients “passed” the battery of PPTs. Upon logistic regression, age and concomitant meniscal surgery were poor predictors of “passing.” In contrast, use of quadriceps was a strong predictor of passing (OR 14.1, 95% CI 2.4-83, p=0.003, compared to BTB). Upon linear regression, use of quadriceps was again a strong predictor of the number of individual PPTs passed (b=1.8, 95% CI 0.33-3.3, p=0.02, compared to BTB). No other demographic variables predicted “passing” or number of individual PPTs passed. Conclusion: Young, active patients undergoing ACL reconstruction with quadriceps autograft are 14 times more likely to meet RTS criteria at 6 months post-op than similar patients with BTB, hamstring or ITB autograft. This may provide valuable insight into the decreased failure rates suggested with the quadriceps autograft. Additionally, this study confirms the majority of these high-risk, young athletes do not meet RTS criteria at 6 months post-operatively.

For postoperative visits, which are often brief interactions between family and clinician, patients may prefer the convenience of receiving postoperative care from home. We evaluated the feasibility of telemedicine for postoperative encounters in pediatric urology.We performed a prospective telemedicine pilot study during an implementation period from November 10, 2017 to March 22, 2018. All postoperative patients deemed eligible by 1 of 4 urologists were offered enrollment in the telemedicine program. Enrollees underwent at least 1 virtual visit within 6 weeks of surgery. Technical difficulties and the number of unscheduled visits and readmissions were noted. After each virtual evaluation the family and clinician were prompted to complete a survey pertaining to perceptions of the telemedicine experience, including how effective the virtual visit was in delivering care. For each virtual visit with a urologist we estimated roundtrip travel cost and time.There was 96% technical success when using the software. A total of 125 postoperative virtual visits were completed in 83 patients. Median age of the children was 3.4 years and 87% were boys. Clinicians found that the virtual visit was "very effective" in 86% of cases, delivering the same care that they would have provided during a visit in person. Families were estimated to have saved a mean $150 travel cost and a median of 113 minutes of travel time per visit. No adverse postoperative outcomes were observed.This pilot study demonstrates that telemedicine can be successfully implemented in the postoperative care of pediatric urology patients.