Disclosures: Cunningham and Gomez report no relevant financial disclosures.
November 19, 2020
3 min read
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Prepare for the snowball effect of delayed eye care

Disclosures: Cunningham and Gomez report no relevant financial disclosures.
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We’ve all read about how people are putting off emergency department and physician visits for heart disease, diabetes and other serious health problems during the COVID-19 pandemic. The same thing is happening in eye care.

When COVID-19 hit our community this spring, routine care for chronic conditions virtually stopped, as did the influx of potentially sight-threatening emergencies. With our offices open, we are now seeing the troubling effects of deferred care first-hand. Comparing our numbers to pre-pandemic norms, we know that pent-up demand is snowballing out there, and we need to be prepared to handle it.

What we’re seeing now

As the pandemic continues, we are seeing an uncharacteristically large number of patients present with advanced cases of diabetic retinopathy, glaucoma and retinal detachment because they have waited months to see the doctor. Patients might notice that one eye has become blurry, and they think, “I just need new glasses. I’ll get them later.” A month later, after it gets worse, they come to our office, and we diagnose a retinal detachment. Even patients with sudden unilateral vision loss have delayed care. They wait, hoping their vision will improve, often with serious consequences.

Further, some patients with known sight-threatening diseases are skipping their injections because they want to avoid the doctor’s office. We’re seeing patients skip appointments for injections to treat age-related macular degeneration or diabetic macular edema. No doubt, some of those patients will have significant vision loss.

Derek N. Cunningham, OD, FAAO
Derek N. Cunningham
Nabila Gomez, OD, FAAO
Nabila Gomez

The snowball effect doesn’t end with retinal disease. Patients are stretching out contact lens wear, so we're seeing more contact lens-related peripheral and central corneal ulcers. We see out-of-control ocular surface disease, particularly in patients with underlying systemic diseases such as connective tissue or autoimmune disorders. We are unable to monitor glaucoma, and we worry that those patients may not remain compliant with drops without a doctor’s reminders and adjustments. For every patient we see, we know more are still at home, waiting as ocular disease progresses.

What we’re doing

To help patients at this juncture and plan for an uncertain future, identifying sight-threatening conditions is a priority. We need to optimize our use of telemedicine to triage patients, inviting the conversations that could reveal if we can help them at home or if they are at risk for vision loss. Through social media and email, we are educating patients about when they need to see us immediately, as well as the importance of not self-extending their scheduled injections with their retina specialist.

This patient presented with progressive macula-involving temporal retinal detachment, the symptoms of which she had been experiencing for a month. Source: Derek N. Cunningham, OD, FAAO, and Nabila Gomez, OD, FAAO
This patient presented with progressive macula-involving temporal retinal detachment, the symptoms of which she had been experiencing for a month. Source: Derek N. Cunningham, OD, FAAO, and Nabila Gomez, OD, FAAO
This patient presented with progressive macula-involving temporal retinal detachment, the symptoms of which she had been experiencing for a month.
Source: Derek N. Cunningham, OD, FAAO, and Nabila Gomez, OD, FAAO

Moreover, we need to help patients manage chronic conditions in a COVID-19 world, which means being less dependent on medication trips to our office. When we meet these goals, patients can maintain their health, even when they are isolated by changing COVID-19 restrictions.

For example, it has always been our goal to reduce or eliminate topical medications for glaucoma, alleviating compliance worries and reducing the frequency of in-office pressure checks. COVID-19 has reinforced this emphasis. We have long been huge proponents of selective laser trabeculoplasty as a first-line treatment because the in-office procedure reduces medication dependence and ocular surface disease, keeping patients out of the pharmacy and quieting compliance concerns.

We have similar goals for patients with ocular surface disease. Because dry eye is a chronic inflammatory condition, we start patients on immunomodulatory drugs such as cyclosporine and lifitegrast early in the disease process. To ease dependence on these medications, we also rely on in-office procedures to re-establish cell function, limit flare-ups and reduce office visits. In normal circumstances, we routinely perform thermal meibomian gland evacuation and lid scurf exfoliation, and we use intense pulsed light therapy to treat patients with ocular rosacea.

As patients return to the practice after having deferred care for ocular surface disease, we’re planning to ramp up these procedures. It’s one way we can prepare for this snowball effect and help patients who are under stress improve their ocular health and quality of life.

For more information:

Derek N. Cunningham, OD, FAAO, practices at Dell Laser Consultants, Austin, Texas. Cunningham specializes in dry eye treatments, glaucoma medications and surgeries, retinal diseases, cataract and LASIK surgeries, cosmetic treatments and vision enhancement.

Nabila Gomez, OD, FAAO, practices at Dell Laser Consultants, Austin, Texas. Gomez specializes in evaluation and management of vision correction surgery, cataract surgery, dry eye disease, ocular surface disease and glaucoma.