Dutch ophthalmologists planning for life after coronavirus

Present efforts must not forget about the future

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Carroll Webers MD, PhD
Planning now for the return to normal practice after the coronavirus pandemic eases is just as important as plans to deal with the virus in the coming weeks, according to the head of the University Eye Clinic Maastricht in The Netherlands. Carroll Webers MD, PhD, has seen how his clinic and academic department normally works change completely in under a week due to the rapid spread of COVID-19 across Europe, and learning about the impact on medical services in Italy and Spain in particular. Dr Webers’ clinic has created a multidisciplinary coronavirus crisis ophthalmology team, including IT staff, medical staff, administration staff and other relevant experts to deal with the situation. Three phases Dr Webers sees three phases to this crisis – having to immediately reduce patient appointments and change how work is done to deal with infection risks; knowing when to reschedule appointments to and redeploying staff as needed to help the hospital deal with COVID-19 cases; and then the return to ‘normal’ work where clinics will be overwhelmed with huge demand. So planning carefully for each phase as much as possible now is essential, he told EuroTimes. Currently the majority of outpatient appointments and surgeries such as cataract and laser procedures have had to be postponed for the majority of patients in the University Eye Clinic, while carrying out essential services in as safe an environment as possible continues. This has involved a lot of practical work and planning in a short space of time. A few years ago there was a very serious outbreak of adenovirus keratoconjunctivitis in Maastricht, which “led us to develop some very good protocols that we are now rewriting into coronavirus protocols as we know from Italy we will shortly have to look after our patients in very special circumstances, with masks and protective clothing”. “It is really the challenging phase now where we would like to do a lot but we cannot, except for emergency services,” Dr Webers added. Retinal detachments, other vital time-sensitive surgery and essential intravitreal injections will be continuing: “Everything that needs to be done will be done.” Already patients with scheduled appointments have had their medical records carefully assessed and triaged by a specialist and contacted to discuss their condition over the phone. They have been given advice such as ensuring they have enough of any necessary medication, and assessed if they really need to be seen or can be rescheduled. Communication with patients needs to be short and very clear, Dr Webers advised. Where patients have to come to clinic, they are asked over the phone if they have any coronavirus symptoms and must not attend if so. Upon arrival at the clinic, their temperature is checked by a non-contact thermometer, and they are assessed by a specialist nurse before being deemed okay to be seen by the ophthalmic team. When indicated, rigorous sanitisation measures are being taken, including the wearing of appropriate personal protective equipment (PPE) by medical staff. Like many countries in Europe, there is concern over shortages of PPE, especially appropriate masks, Dr Webers said. Another key challenge has been ensuring that private ophthalmology practices are following the same protocols as public facilities, Dr Webers, who works at a number of private clinics operated by the hospital, said, in relation to infection control, and management of patients. “That was something we needed to address immediately. While many ophthalmology staff like Dr Webers’ team are currently in the first ‘quiet’ phase, trainee doctors who are undertaking PhDs and have exams later in the year should take this time to study, he said. Some staff will be redeployed to help in the hospitals and need to prepare and update their skills where possible to deal with this. “When clinics return to full opening, we will have to catch up with everything that has been delayed; cataract surgeries, vitrectomies and so on. We are already making plans for doing extra clinics and weekend surgery when this happens, though of course staff will need time off after the crisis so a lot of preparation will be needed,” he said.