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Disclosures: No products were mentioned that would necessitate financial disclosure.
April 14, 2020
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BLOG: Another perspective on the role for optometry in a pandemic

Source/Disclosures
Disclosures: No products were mentioned that would necessitate financial disclosure.
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As the days drag on for many of us sheltering at home, there is plenty of time for us to consider our personal role in this pandemic as well as that of our profession.

I posted a recent blog of my opinion that most optometrists should stand down, close their offices and play only a supporting role with telehealth solutions. I believe that, under most circumstances, optometrists who are physically seeing patients during a shelter at home order are part of the problem rather than part of the solution. Not everyone with an essential role in health care belongs on the front lines of face-to-face patient care in a pandemic.

I will hold that opinion even if the eventual course of COVID-19 shows a low death rate and sizable blow to our economy. Public health and safety will always be more important than financial consequences in my book.

This blog, and frankly all blogs, is opinion-based and not a news item. I respect others and their opinions and believe friends and colleagues can agree to disagree. In the spirit of that commitment, I am turning over this edition of my blog to my good friend, David W. Nelson, OD, MBA, a board-certified optometrist and a past president of the American Optometric Association. He is an important thought leader of our profession. – by Scott A. Edmonds, OD, FAAO

From Dr. Nelson

David W. Nelson, OD, MBA
David Nelson

The CDC has made the recommendation that optometrists should discontinue routine examinations due to the current outbreak of COVID-19. Dr. Scott Edmonds, this blog host, has written in favor of optometrists discontinuing “routine care” at the CDC’s direction.

As a primary care optometrist with a medical focus (as all optometrists are trained in their educational programs today), I disagree with conventional thoughts regarding the perception of what a routine exam entails in 2020 and feel they should be continued with proper precautions.

Optometrists see a wide range of individuals in their general practices. Some optometrists specialize in certain practice areas limited to a very small range of activities. The breadth of these small areas, however, is significant, so it really cannot be addressed from a primary health standpoint. A large majority of optometrists practice in a very traditional way historically, but with the advance of therapeutic treatments, most optometrists practice with, at the very least, the responsibility to identify and possibly manage a range of common eye diseases.

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The reason optometrists need to continue practicing beyond a limited “emergency” basis for this nation’s overall health is because a “comprehensive routine exam” is not the routine exam perception that the CDC seems to think of optometric practice.

Everyone seems to like the idea of mathematical models today in this over-charged atmosphere of COVID-19. And, yes, everyone has seen the changes in emergency hospital care when the curve is not flattened. I am not making an argument not to change the way we see people, but with the proper screening techniques, for the most part, we can see people safely in many areas of the country.

The math I am speaking of in eye care is the percentage of people who present for a routine exam and have a sight-threatening or life-threatening situation. For instance: glaucoma. Eight percent of people in the U.S. have a diagnosis of glaucoma, and half of the people who have it don’t know they have it. In diabetes, the incidence from the CDC is 10.5%, and 88 million are pre-diabetic. In obesity, we know that two-thirds of individuals are overweight, and one-third morbidly obese. From an age standpoint, nearly 20% of “healthy” people have a disease that can affect eyes, and after age 60 that incidence can approach 50%. Every doctor gets the call for pink eye, flashes and floaters and dry eye at least once a day. If there are 18,500 offices closed, you can easily surmise that this care will get pushed down the road to a later date or into an emergency department. I was sent a corneal abrasion from an emergency room last week, so they did not have to go through their COVID-19 protection procedures to take care of this patient. Luckily, my staff took the call and, based upon the way we operate, she was seen about an hour later and extremely happy not to have to subject herself to the risk associated with being seen in a hospital.

My opinion that an optometrist should stay open for more than emergency only care is for two reasons. First, today’s routine visit is usually not as the historical routine, particularly from a percentage basis due to today’s changing practice of optometry. Second, optometrists can play a very significant role in reducing unnecessary visits to secondary care and/or emergency department visits that are already overwhelmed.

Finally, I would like to comment from a broad-based perspective of eliminating our national economic production. The 8 weeks (current shutdown timeframe) will be far more destructive due to all-cause death increases in the country due to side effects of such a shutdown: suicide, heart attacks, diabetics, etc. If the CDC studies the all-cause death increases of the 18 to 24 months in light of the pandemic COVID-19 total deaths, the death rate increase will be greater than the COVID-19 death total, which is projected today to be between 100,000 and 242,000.

Disclosure:No products were mentioned that would necessitate financial disclosure.