Clinician combines in-office visits with telehealth during pandemic
The necessity for quarantine during the ongoing COVID-19 pandemic has led many specialties, including eye care, to adapt to new technologies for telehealth and develop procedures to best meet patients’ needs.
Healio Primary Care Optometry News spoke with Scott Schachter, OD, a practitioner at Vision Source in Pismo Beach, Calif., and the founder of the Ocular Surface Academy, on alterations he has made in his practice over the last few months.
Healio: What changes have you made in your practice because of the pandemic?
Schachter: To limit exposure to COVID-19, we developed new office efficiencies and condensed the schedule to reduce patient days from 5 per week to 3. Due to my travel schedule, my practice was already primed for this scenario, and it was not a huge leap to make. To achieve this without creating a patient backlog, we emphasized the importance of filling all appointments each day to avoid wasted slots and implemented protocols to streamline the patient experience. This included training additional staff to work the technical aspects of outpatient visits to smoothly and safely move patients through their appointments on the designated days.
On days that I am not seeing patients, my staff is still at the clinic so patients can pick up products. We will also occasionally have patients come in for glaucoma or age-related macular degeneration testing. These patients are scheduled far apart to allow adequate time for testing and equipment use without putting patients and staff at risk. This has the added benefit of ensuring the equipment is readily available on regular patient days.
We require our patients and staff to wear face masks while in the clinic, provide hand sanitizer as patients enter, and screen everyone for symptoms and possible exposure to the virus. We have also initiated elevated disinfection standards. In addition to standard best practices, we clean with hypochlorous acid after every patient and mist the entire practice with a protective surfactant every 30 days. This is a spray compound of nanosized silicon dioxide that works using a mechanical mechanism, rather than chemical, to kill viral pathogens upon contact.
However, my favorite change is that we all wear scrubs now — I never have to think about what to wear anymore!
Healio: How are you using telehealth in your practice?
Schachter: After shutting down the office to comply with government mandates, telehealth became integral to my practice, and it continues to be. This option is particularly beneficial for the at-risk population, sparing them from unnecessary exposure. It is also proving an excellent tool for encouraging treatment compliance of my patients with ocular surface disease. Scheduling online appointments between in-person visits helps drive the importance of sticking to the treatment plan.
Previously, I would follow up with a dry eye patient after 30 days. With telehealth, I can see patients after 10 days, which is a big inducement for adherence.
While the office was temporarily closed to patients, I saw patients using telehealth from my home. Since then, we have set up a workstation for telehealth appointments. Patients make an appointment, and at the designated time a staff member starts the online visit by taking the patient’s history and, if necessary, assists the patient in photographing and uploading images of their eyes into the portal. I pop in to look at the images and spend a few minutes with the patient asking about their symptoms, whether they are following the treatment plan and how well they are tolerating everything.
Access to telehealth is widely available to my patients. They only need an internet connection and a smartphone to take and upload a picture of their eye. We use EyecareLive, which offers patients the option of an app-based or web-based platform. We found that our elderly population responds more favorably to the web option because, overall, this demographic is reluctant to download and use apps on their phone.
Healio: How has dry eye sustained your practice?
Schachter: Screen time has risen in proportion to at-home time and, consequently, so have dry eye symptoms. I am seeing more complaints of dry eye and red eye, styes and chalazion across all age groups, including children. My optometry practice provides primary care with a big slant toward treating ocular surface disease, and I consider every patient at risk for OSD. By paying attention to the ocular surface and treating it, I have developed a reliable patient base who return for regular follow-up visits and to purchase products that treat OSD. While it is necessary to have the patient in the office for diagnosis and certain tests, I can do a lot of follow-up via telemedicine.
I take a stepwise approach to OSD treatment following the Tear Film & Ocular Surface Society Dry Eye Workshop II algorithm. A validated symptom questionnaire such as SPEED [Standardized Patient Evaluation of Eye Dryness], OSDI [Ocular Surface Disease Index] or DEQ-5 [Dry Eye Questionnaire-5], helps identify potential dry eye, and I perform MMP-9 testing (InflammaDry, Quidel) and lower lid meibography for baseline measurements to follow changes during the course of treatment. Treatment initiates with a discussion regarding lifestyle changes, such as reducing screen time, and a regimen including nutraceuticals (HydroEye, ScienceBased Health), lid hygiene and artificial tears. Nutraceuticals allow me to treat patients systemically from the inside out, while topical treatments provide immediate symptom relief. I perform in-office lid cleansing with ZocuShield (Zocular) and recommend my patients use ZocuFoam (Zocular) at home as well. If the severity of DED indicates, we then move on to immunomodulators, steroids or other therapies as needed.
Healio: What do you see for your practice 6 months down the road?
Schachter: That is a hard question; right now, it is difficult to predict what things will look like a week from now. Regardless of what happens, we will continue the 3-day patient week and wearing our comfortable scrubs!
For more information:
Scott Schachter, OD, practices at Vision Source in Pismo Beach, Calif., and is the founder of the Ocular Surface Academy. He can be reached at firstname.lastname@example.org.