Teleophthalmology and Teleglaucoma in Clinical Practice: Attitudes of Ophthalmologists in Bulgaria

Background: Over the past two decades, teleophthalmology has become an effective approach for glaucoma screening and follow-up, with its adoption markedly accelerated by the COVID-19 pandemic. Objectives: The aim of the present study was to explore and analyze the attitudes of ophthalmologists in Bulgaria toward the application of teleglaucoma, digital communication, and artificial intelligence in clinical practice. Methods: A cross-sectional survey study was conducted among 113 ophthalmologists between September 2024 and March 2025, representing 10.5% of all licensed ophthalmologists in Bulgaria (n = 1074). Results: Age, professional experience, and specialization influenced the level of involvement in managing glaucoma patients. The level of awareness regarding the term 'teleophthalmology' was higher among respondents with a specialization in ophthalmology and those holding a doctoral degree (p = 0.001). Among the ophthalmologists surveyed, 35.4% (n = 40) provided teleophthalmology services, while an additional 19.5% (n = 22) reported no prior provision of such services but planned to do so in the future. The most preferred method for conducting teleophthalmology consultations was telephone communication (n = 27; 67.5%), followed by communication via Skype, Viber, or Messenger (n = 23; 57.5%). Physicians with longer professional experience more frequently conducted remote consultations with patients they already knew (p = 0.006). A substantial proportion of respondents (85.0%, n = 96) expressed willingness to participate in training related to contemporary trends and the provision of remote medical services. More than half of respondents expressed positive attitudes toward the use of artificial intelligence in ophthalmology, although practical implementation remained limited. Conclusions: The present study outlined the current landscape of attitudes among ophthalmologists in Bulgaria toward teleglaucoma, digital communication, and the use of artificial intelligence in clinical practice. The findings indicated a moderately positive yet cautious stance-remote services were perceived primarily as complementary tools, particularly for the follow-up of previously known patients and for real-time collaboration between specialists.