This online discussion will be held Monday, Sept. 28 from 12:30 p.m. to 1:30 p.m. and is designed for general practitioners, family practitioners and other healthcare providers.
Dr. Rahul Bhola, medical director of ophthalmology at CHOC, will present information on several topics, including the milestones of visual development and measuring visual acuity in children. Dr. Bhola will also discuss ways to manage common pediatric ocular disorders, as well as how to determine when a child should be referred to an ophthalmologist.
This virtual lecture is part of a series provided by CHOC that aims to bring the latest, most relevant news to community providers. You can register here.
CHOC is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians and has designated this live activity for a maximum of one AMA PRA Category 1 Credit™.
Please contact CHOC Business Development at 714-509-4291 or BDINFO@choc.org with any questions.
Ophthalmology might not be the first specialty that comes to mind when envisioning a telehealth practice, but Dr. Rahul Bhola, medical director of ophthalmology at CHOC Children’s, has seamlessly integrated the service in his practice, completing more than 900 telehealth visits since March.
In this Q & A, Dr. Bhola outlines his team’s success in transitioning to telehealth, and shares best practices that physicians in a variety of specialties can put into practice:
What does an ophthalmology telehealth appointment look like?
A synchronous (live audio-video) CHOC ophthalmology telehealth appointment is divided into four components. I call them the four C’s: contact, connect, consult and care.
Contact Our front desk reaches out to the family to confirm contact information. We send a Zoom link to the families, along with information about how to connect to Zoom and download the visual acuity app to check vision before the appointment.
Connect As the appointment day approaches, our technician connects with the family to discuss any technical issues that should be resolved prior to the physician consultation. The technician also goes over the at-home visual acuity check and evaluates basic medical history.
Consult On the actual day of the appointment, the physician connects with the families on Zoom to go over the pertinent history and visual acuity, and performs a focused examination including an external and ocular motility exam. If needed, pictures and videos from the family are requested for further evaluation. This enables us to diagnose a majority of anterior segment ocular issues as well as visual acuity concerns like amblyopia, refractive errors and ocular motility disorders.
Care We discuss the treatment care plan and review any medical issues or concerns the patient is experiencing. Throughout this process, we can fulfill their needs ranging from prescription refills for medication or broken glasses without them having to step outside the comfort of their home.
Our office will then schedule a follow-up visit depending on the medical necessity.
How do your patients and families feel about telehealth?
While some physicians may have been wary of telehealth care, I was pleasantly surprised that patients love telehealth.
Telehealth helped our patients and families feel secure, supported and assured that there would be no interruption in the patient’s care plan during COVID-19. Our families are so grateful that during this time of emergency, their physician was able to connect with them to address any urgent issues and follow them in clinic on a need-to basis.
Due to the positive response we have received from our families, we will continue to offer telehealth visits for our families, when appropriate.
Does telehealth compromise quality of care?
Not at all. Providers are often able to spend more time with patients during a telehealth visit. Children are more comfortable in their home setting and you can engage more with them and spend more time on-screen with them.
If we felt the urgency to see our patients face-to-face after the initial exam, we schedule in-person appointments.
What makes your telehealth visits successful?
The expression “Necessity is the mother of invention” really is true when it comes to telehealth. Telemedicine has been around for a while, but it took a pandemic to make it universal and successful. As soon as the stay-at-home orders were announced we knew we had to connect with our patients to prevent any disruption of their care. Our team was not afraid of change and we realized the urgency to adapt to the circumstances right away to provide uninterrupted care to our patients and their families. We reallocated our resources to maximize our outreach; our goal was to connect with each and every patient scheduled to be seen in the clinic.
What advice and tips do you have for other providers to do telehealth successfully?
Being open minded, adaptable to the changing circumstances and embracing technology were a few things that helped us during this unprecedented time. We created a vigorous team of both technical and non-technical staff in a short span of time to enable successful initiation of a robust tele-ophthalmology program. The key was strategizing dynamically in this constantly changing environment and having frequent huddles with the team to address any issues.
Very quickly we realized that telehealth was amazing to address the four-part aim of healthcare: access, cost-effectiveness, patient satisfaction and physician satisfaction.
There will be nuances for specific specialties. In our case the American Academy of Ophthalmology right away provided resources and tools to help us initiate an effective synchronous telehealth portal.
Technological innovations like visual acuity apps and the ocular motility app were phenomenal tools developed to assist effective consultations.
An internationally recognized pediatric ophthalmologist with expertise in strabismus, amblyopia, pediatric cataracts and glaucoma has joined CHOC Children’s. Dr. Rahul Bhola is the newest division chief of ophthalmology with CHOC Children’s Specialists.
“The biggest reason I was inspired to join CHOC was the mission of the hospital. I feel that CHOC’s mission to nurture, advance and protect the health and well-being of children is in close alignment with my personal goals as a physician,” Bhola says. “I seek to nurture the health care of children by delivering state-of-the-art ophthalmology care to our community. CHOC has the resources, reputation and experience to provide excellent care.”
Dr. Bhola comes from a family of physicians. His parents practiced internal medicine for more than 40 years in India, and the empathetic and holistic care they provided to their patients inspired him to pursue a career in medicine.
“Very early on in medical school, I developed a special interest in pediatrics, and the surgical finesse of ophthalmology later cemented my passion for pediatric ophthalmology. The gift of vision is the most important sense a child can have,” Dr. Bhola says. “Giving a ray of light to those who struggle with vision is very gratifying to me. Treating children is important to me because they have their entire lives ahead of them, and improving their vision positively impacts their entire family.”
Dr. Bhola attended medical school and completed an internship at University College of Medical Sciences in Delhi, India. He completed two residencies in ophthalmology at Maulana Azad Medical College in New Delhi, India and the University of Louisville, Kentucky. He pursued fellowships in pediatric ophthalmology at the Jules Stein Eye Institute at the University of California Los Angeles and the University of Iowa.
Dr. Bhola has received numerous awards both nationally and internationally and has extensively published in peer-reviewed journals. He has participated as an investigator in many NIH-sponsored trials and has been named to the “Best Doctors in America” and “America’s Top Ophthalmologists” lists consecutively for many years. Dr. Bhola recently started studying the ocular effect of excessive smart device usage in children. His research includes tear film composition in children who are consistently overexposed to smart devices, thereby establishing a link between dry eyes in children and excessive smart device usage.
At CHOC, Dr. Bhola will provide comprehensive eye care, treating patients with a variety of eye diseases and disorders. In addition to treating refractive errors (the need for glasses), Dr. Bhola will provide more specialized care for diseases like amblyopia (lazy eyes), pediatric and adult strabismus (crossing or drifting of eyes), blocked tear duct, diplopia (double vision), pediatric cataracts, pediatric glaucoma, tearing eyes, retinopathy of prematurity, ptosis (droopy eyelids), traumatic eye injuries and uveitis.
Dr. Bhola is among the very few surgeons nationally skilled in treating pediatric glaucoma surgically using the illuminated microcatheter. This highly-specialized, minimally-invasive approach of canaloplasty has been used for treating pediatric glaucoma only within the last few years. Childhood glaucoma, though uncommon, can be a blinding disease causing severe visual impairment if not detected early and treated promptly. The onset of juvenile glaucoma often occurs between the ages of 10 and 20 and can be multifactorial. Glaucoma in pediatric population can also be secondary to trauma occurring from any form of injury including sports injuries.
As a Level II pediatric trauma center, and the only one in Orange County dedicated exclusively for kids, CHOC’s trauma team treats a variety of critically injured children from across the region. This includes children who have sustained sports injuries, during which damage to the structure of the eye can cause glaucoma.
Dr. Bhola is very passionate about educating primary care physicians on the need for regular pediatric vision screenings. For example, children complaining of headaches may be taken to a neurologist. However, eye problems such as refractive errors, convergence insufficiency and strabismus can result in headache from excessive straining of the eyes, which may affect school performance and even social withdrawal in some children. These conditions are likely to be identified at regular vision screenings.
Dr. Bhola’s philosophy of care is to treat his patients as if they were his own children.
“My main philosophy is to deliver patient-centered care with compassion and excellence. I remember their life events and celebrate their achievements with them. It’s important that a patient remembers you in order to start to build trust with them. I love when my patients send me holiday cards and copies of their school photos and let me know how they are doing. They became part of my family. I always treat every patient like they are my own child,” Bhola says.
He also focuses on treating the whole person rather than the disease, and involving patients in their care.
“I don’t treat the disease, I treat the individual. Healing is more than treating the disease. I want to be at their level so I always talk to them directly and not only talk to their parents. I involve their entire group during treatment,” he says.
At CHOC, Dr. Bhola is eager to provide holistic eye care for his patients.
“My practice will offer complete comprehensive vision care to all patients, which includes both medical as well as surgical care. Our patients come to us for glasses, contacts, regular ocular screenings, and we also provide more specialized care like glaucoma, cataract and strabismus surgeries,” Bhola says. “A lot of systemic disorders such as diabetes, sickle cell anemia, juvenile rheumatic disease and lupus, have co-occurring eye issues that may go undetected if children aren’t seen for regular eye screenings. CHOC patients with systemic disorders such as diabetes now have better access to holistic care.”
As division chief for CHOC Children’s Specialists ophthalmology, Dr. Bhola is passionate about providing state-of-the-art care to patients and training the next generation of pediatric ophthalmologists.
“My main goal is to build a leading ophthalmology division, not only delivering excellent patient care but also engaging in cutting-edge research and disseminating education to the next generation of ophthalmologists and referring providers,” Bhola says.
When not treating patients, Dr. Bhola enjoys cooking, practicing yoga and meditation, and spending time with his wife and two daughters.
To contact Dr. Bhola or refer a patient, please call 888-770-2462.
CHOC Children’s virtual pediatric lecture series continues with Vision Screening: Refresher for Primary Care Clinicians.
This online discussion will be held Monday, Sept. 28 from 12:30 p.m. to 1:30 p.m. ...
Ophthalmology might not be the first specialty that comes to mind when envisioning a telehealth practice, but Dr. Rahul Bhola, medical director of ophthalmology at CHOC Children’s, has seamlessly integrated ...
In this CHOC Children’s grand rounds video, Dr. Chantal Boisvert, neuro-ophthalmologist, addresses optic neuritis in pediatric patients. Specifically, she discusses how the presentation and outcome can be different for children ...
In this CHOC Children’s grand rounds video, Dr. Chantal Boisvert, neuro-ophthalmologist, addresses optic neuritis in pediatric patients. Specifically, she discusses how the presentation and outcome can be different for children compared to adults. Pediatric optic neuritis is often bilateral and tends to occur within one to two weeks after a known or presumed viral infection/vaccination. Children with optic neuritis are also at lower risk of developing MS compared to the adult population.
Dr. Boisvert also shares some of the challenges associated with diagnosing and treating optic nerve problems. Sudden inflammation of the nerve, which carries visual information from the eye to the brain, can cause acute vision loss. Most cases will improve after a few weeks, but injury to the nerve fibers can sometimes result in permanent loss of vision. Physicians need to know when to refer to neuro-ophthalmologists. Neuro-ophthalmologists are familiar with all aspects of both optic nerve and brain disorders, and will be able to provide up-to-date recommendations on complex treatment issues and follow-up.