How to Reopen Eye Practices During the Pandemic

By Rishi P. Singh, MD

The curve has flattened. Social distancing during the COVID-19 pandemic has succeeded in reducing the anticipated incidence of infection. Unfortunately, it also succeeded in reducing the clinical volume of many medical practices.

Ophthalmology was the hardest-hit specialty, with a 79% drop in patient visits from early March to early April, according to researchers at Harvard University and healthcare technology company Phreesia.

Now that social distancing efforts are relaxing, we are preparing for another unprecedented experience: reopening medical practices and resuming patient visits while COVID-19 continues to loom.

Will the incidence of cases spike as stay-at-home orders are lifted? How do we provide eye care for patients while reducing the risk of viral transmission? How do we protect caregivers? There’s a lot we soon will learn.

At Cole Eye Institute, we are planning to use a variety of tactics to restart our practice in the safest way, including:

• Virtual visits. Telehealth appointments became a viable option for ophthalmology patients during the COVID-19 crisis. And they will continue to be. The more patients we continue to see via video chat, the more we can potentially curtail viral transmission.
• Hybrid visits. We have begun to experiment with hybrid visits, a combination of in-office and virtual visits. Patients briefly come to the office to get a tonometry reading, for example, or have another diagnostic procedure. Providers later conduct a virtual visit to discuss diagnostic findings and a care plan. We have been offering hybrid visits for general ophthalmology, glaucoma and retinal patients, and now are conducting at least a portion of visits virtually for nearly 30% of our patients.
• Expedited appointments. Patients are called the day before their appointments, and their history of present illness, medications, allergies and past history are documented. When patients arrive at the office, the amount of time they spend with the technician is dramatically reduced (on average by 25%), so there is less face time and exposure for everyone involved.
• Remote monitoring. Remote monitoring also will help reduce the time patients spend at in-office visits. With some innovative tools, patients will be able to take diagnostic tests at home and bring results to their appointment. For example, the ForeseeHome monitoring program is an effective tool for helping manage patients with dry age-related macular degeneration (AMD). It integrates with the electronic medical record, through which providers can order tests and review results. Another innovation on the horizon is at-home optical coherence tomography for patients with AMD, diabetic retinopathy and retinal vein occlusion.
• New clinic workflows. Ophthalmologists see 40-60 patients per day, on average. That can make social distancing in clinic a challenge. We are addressing this by: checking the temperature of patients when they arrive; providing masks; increasing space between seats in the waiting room; limiting movement between rooms; and omitting diagnostic testing when possible. We also will increase time between appointments (and lengthen office hours) to lighten the flow of patient visits and minimize the number of people in clinic at one time.
• Changes in surgery centers. Structural changes will include: enhanced ventilation and air filtration if needed, and clear plastic barriers to reduce viral transmission. COVID-19 testing will be standard before any procedure.

These changes will become the new normal for Cole Eye Institute and, likely, other eye clinics. They are the first of many ways we all will need to adapt to continue keeping COVID-19 at bay.

Dr. Singh is an ophthalmologist at Cleveland Clinic’s Cole Eye Institute.

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