Caring for blind and vision‐impaired dermatological patients during the COVID‐19 pandemic

Dear Editor,

The novel coronavirus disease 2019 (COVID‐19) has caused drastic interruptions in traditional dermatological patient care. In 2015, it was estimated that 36 million people were blind and 217 million people had moderate to severe vision impairment. ¹ Blind and vision‐impaired (BVI) patients face unique challenges, with high health care expenditures, further exacerbated by the pandemic. ² This letter addresses strategies for mitigating barriers for BVI patients in receiving dermatological care during the COVID‐19 pandemic.

When appropriate, dermatologists should defer in‐person visits for BVI patients to decrease viral transmission and fall risks, as well as to reduce transportation costs. The Center for Disease Control recommends standing six feet away from other people, ³ which may be difficult with public transportation, and many BVI patients may not perceive distance well. BVI patients often rely on tactile information, and are thus more likely to touch public spaces and surfaces that could be colonized with COVID‐19. ³

Telemedicine may provide increased access to dermatological care for BVI patients, which could reduce stress in navigating public spaces and limit COVID‐19 transmission risk. Table 1 summarizes suggestions for improving care for BVI patients during a virtual dermatological visit. The dermatologist should vocally greet the patient initially to signal entry into the virtual room and the start of the encounter. It is important to be aware that the patient, depending on the severity of vision loss, may not be able to describe the skin concern. The patient may be guided to gently run the fingers over the lesion to describe its tactile features and assess skin mobility. Handheld devices are preferred over stationary technology to assist patients in pointing the camera at the area of interest. If possible, use assistance from a family member or caregiver. Use accurate and specific language when giving directions. The “clockface” method may be a helpful technique.

TABLE 1.

Suggestions for improving virtual care for blind and vision‐impaired patients

Instructions in various formats	Visual and audio instructions should be provided Written instructions should have the following: minimum size 16 font, bold type face, 1.5‐line spacing. Avoid stylized and light fonts, capitalized, italicized and underlined text
Use accurate and specific language	Use specific spatial instructions. For example, “move your camera to the left” rather than “move the camera over there” The “clockface” method can be used. For example, “the lesion is on your forehead in the 1 o'clock position”
Reduce steps to connect	Decrease confusion by using systems that allow for one click to enter the video call Send links to the virtual visit via text message or e‐mail
Allow audio recording for follow‐up instructions	If providing information for later use, give patients the option of recording your instructions so that they can listen at a later time
Provide a trial run	Have an office member simulate a trial run with the patient to troubleshoot the patient's needs prior to the appointment

When providing follow‐up instructions, give patients the option of recording the information so that they can review them at a later time. Directions should be provided in both written and auditory formats. Written documents sent via e‐mail should have a minimum font size of 16. Avoid stylized and light typefaces, and instead use bold or semibold fonts. Avoid blocks of capital letters, underlined or italicized text. It is best to use 1.5‐line spacing and high contrast (black text on white background). ⁴ There are screen readers for blind individuals and screen magnifiers for low vision. ⁵ However, not all patients have access to this technology; it is best to call ahead with oral instructions as well.

It is essential to provide BVI patients with high‐quality dermatological care during the COVID‐19 pandemic. This can be especially challenging for dermatologists who often give visual cues. Strategies used for each BVI patient will vary depending on the severity of vision loss. We hope our that our letter encourages awareness of the unique needs of BVI patients and that the dermatology community employs these strategies to better accommodate these patients.

CONFLICT OF INTEREST

The authors declare no potential conflict of interest.

DATA AVAILABILITY STATEMENT

Data is sharing not applicable as no new data were generated, or the article describes entirely theoretical research.