How optometrists are practicing amidst COVID-19
Primary Care Optometry News reached out to doctors of optometry around the country to inquire about how they are dealing with the COVID-19 pandemic in their practices.
All nine respondents said they have reduced or canceled non-emergency consultations, with some unique approaches to safely see patients most in need.
Richard Mangan, OD, FAAO, assistant professor in the department of ophthalmology at the University of Colorado and a PCON Editorial Board member, reported that his office remains open with a skeleton staff for emergency patients. Additionally, all doctors went through in-house telemedicine training to better triage patients, and at least one resident or fellow was assigned to the call center.
“As news of the virulence and contagiousness of COVID-19 became a reality, our department had a faculty meeting in the middle of March to discuss the situation,” Mangan told PCON. “It was ultimately decided that in the best interest for our patients, staff and faculty that the schedule be ‘scrubbed’ clear. This means that each doctor reviewed his or her clinic schedule and decided who could be moved. Patients who were considered high risk were seen as scheduled. These patients might have conditions like corneal ulcers, neo-vascular glaucoma, etc.”
PCON blogger Margie Recalde, OD, FAAO, of Lifetime Optometric in Fresno, Calif., is also hoping to make use of telemedicine to minimize disruption. Specifically, she is looking into using a telemedicine app to help improve communication with patients. Her practice is also triaging urgent care patients over the phone to determine if they need to be seen in the office.
“I think twice about seeing patients who have a fever, upper respiratory symptoms, recently traveled to high-risk countries or hot spots in the U.S., or have been in close contact with someone diagnosed with COVID-19,” she continued. “Due to the lack of PPE [personal protective equipment], I will be referring patients to other eye care practices if they are high-risk for COVID-19.
“My husband is a nurse and still has to go to work at the hospital every day,” she continued. “Consequently, I need to be extra careful to minimize risk for exposure for the sake of our kids. Now more than ever, we must all do our part to stay home to save lives and flatten the curve.”
While not all clinics have access to appropriate PPE, Joseph P. Shovlin, OD, FAAO, who practices at Northeastern Eye Institute in Scranton, Pa., and is also a PCON Editorial Board member, said he and his colleagues have been able to use gloves, masks and shields while examining patients. He also said that they encourage patients to remain silent during the slit-lamp exam.
“Since conjunctivitis may be an early sign, we are committed to caring for these patients. This is the perfect incentive to get up and running with telemedicine for those who have not done so to date,” Shovlin said. “We do have a dedicated room with appropriate PPE for confirmed cases of coronavirus that have to be seen for emergent issues (retinal detachment, uncontrolled IOPs, corneal and intraocular infections, etc.). Unfortunately, we expect the number of confirmed cases to increase, so we continue to monitor and adjust our office policies.”
In early February, Karen Perry, OD, FAAO, a PCON Editorial Board member who practices at the Vision Health Institute (VHI) in Orlando, Fla., and colleagues instituted added precautions, including prescreening patients and posting signs at the front door and all high touch areas. Staff also underwent training for cleaning protocols per the CDC guidelines and have reduced hours, with teams working alternate days.
“We are fortunate that VHI was previously a bank. We retained the drive-thru to dispense contact lenses and other eye wear requiring simple adjustments,” Perry said. “This feature has proven to be a great resource for the practice in reducing direct public contact.”
Perry also noted that staff were ensured of ongoing efforts to sustain operations and retain all employees.
“An email was sent to all patients reminding them to purchase contact lenses. Expiration dates were waived,” she said. “This generated $13,000 in contact lens sales over a 48-hour period.”
Shane Kannarr, OD, from Kannarr Eye Care in Pittsburg, Kan., also devised an altered working schedule. Initially, the practice divided staff into three teams with one doctor at the clinic at a time and allotted 30-minute blocks for each appointment. They also encouraged patients to bring only the necessary people with them to the office, with a limit of 10 people in the clinic.
“The situation is constantly evolving, however, and more cases of COVID-19 were identified in Pittsburg this week. Starting March 30, we will further scale back our operations,” Kannarr told PCON. The new schedule involves two staff members working limited hours. Patients picking up glasses, contacts or requiring repairs are directed to call ahead, with doctors providing 24-hour emergency coverage.
“This is an unprecedented and uniquely stressful time for our entire country,” he said. “Our practice, however, will continue to deliver the highest quality care possible to our patients, while monitoring the situation frequently, ensuring we are poised to change procedures as necessary. As soon as it is safe and prudent to do so, we will return to a normal schedule.”
Arthur B. Epstein, OD, FAAO, head of the Dry Eye – Ocular Surface Disease Center and director of clinical research at Phoenix Eye Care – the Dry Eye Center in Phoenix, agreed with Kannarr. “This crisis is unprecedented in modern history and is in constant flux,” he told PCON. “While we hope that it is brought under control rapidly, we have to . We have reduced employee hours and implemented other ways of reducing costs. Our goal is to keep the practice functioning to meet patient needs and keep our staff employed.”
Epstein said that his practice is following the CDC guidelines and only seeing urgent and emergency patients. At the beginning of the U.S. outbreak, they implemented stringent cleaning protocols, including frequent disinfection of all “high touch areas” along with thorough disinfection of examination rooms and equipment in front of the patient.
“This is a scary time for everyone, so reassuring patients that we are protecting them is critically important,” he said.
Highlighting the CDC guidelines, John A. McCall Jr., OD, who practices at Crockett Vision Source in Crockett, Texas, and is a PCON Editorial Board member, shared the steps his practice uses to prescreen patients in need of an urgent consultation. Patients are invited into the clinic only if they have problems being able to see, eye pain, red eye, flashes or new floaters or had cataract surgery within the past week. Otherwise, routine appointments were rescheduled for April 13 or later.
“We will schedule only one patient per hour to avoid any overlap between patients and to keep within the guidelines of only 10 people or fewer in our clinic at any one time,” McCall said.
As with the other doctors interviewed, PCON Editorial Board member Justin Schweitzer, OD, FAAO, from Vance Thompson Vision in Sioux Falls, S.D., and Damon Dierker, OD, FAAO, from Eye Surgeons of Indiana, are following the CDC guidelines and have limited patient visits to emergency care.
“Patients who do need to be seen are greeted at the door and asked a few COVID-19 screening questions and are asked about a recent cough, fever or other symptoms specific to COVID-19, and each patient has their temperature checked,” Schweitzer told PCON. “We have very limited staff in the center and, to protect them, all are wearing masks, eye wear and gloves as they interact with patients.”
Dierker explained that their retina specialist continues to perform dozens of intravitreal injections daily, wearing a mask and gloves for all patients.
“Overall, our patient volume is about 10% compared with normal, and most of these are retina patients needing injections,” he said “I am very interested in incorporating telehealth and I feel much better prepared after listening to a few webinars and conversing with colleagues this week. I will plan to initiate this next week and am deciding whether I need to invest in a specific telehealth platform. We are proud to say that we have not furloughed or laid off any staff.” – by Talitha Bennett
Disclosure: No products or companies that would require financial disclosure are mentioned in this article.