Future of ophthalmic practice

The COVID-19 pandemic has drastically limited ophthalmic care and has ramifications for its delivery in the future. In an article published in the Journal of Glaucoma, Jeffrey M Liebmann, MD, addressed the question: “What will tomorrow look like when it comes to the practice of ophthalmology and ophthalmic surgery?”. https://journals.lww.com/glaucomajournal/Citation/9000/Ophthalmology_and_Glaucoma_Practice_in_the.97908.aspx Outlining the issues that will be confronted, Dr Liebmann emphasised the need to act now to initiate new paradigms for eye care delivery. Dr Liebmann, Professor of Ophthalmology and Glaucoma Service Director, Columbia University Irving Medical Center, New York, NY, USA, noted that telemedicine may be more widely adopted for certain tasks, such as for postoperative follow-up after routine cataract surgery in non-glaucomatous eyes or for collecting medical history and present illness information prior to a scheduled visit. However, telemedicine is not well suited for performing a detailed intraocular examination and surgery. With the need for in-person visits, numerous changes will have to be implemented. These relate to the types of instruments and medication bottles used (i.e., reusable/multidose vs disposable/single-use), instrument cleaning and sterilisation processes, and establishing protective barriers. Dr Liebmann pointed out that pneumotonometers and air-puff tonometers may need to be avoided because they might generate viral particles from the tear film. He also noted that use of automated perimetry presents a particular challenge since the perimetry bowl is a potential source for viral spread and is difficult to clean without damage. Dr Liebmann called on equipment manufacturers to help with designing new care protocols for their products and on clinicians to begin research to develop and validate new diagnostic and monitoring paradigms in case automated perimetry cannot be done safely or is allowed only for certain circumstances. Measures to maintain physical distancing between patients and staff will also be required. This will involve reconfiguring of the physical footprint of the clinic or office and of appointment scheduling to limit the number of patients in the waiting area. With care delayed for so many patients and the need to maintain physical distancing, Dr Liebmann stated that office hours will need to be expanded. He suggested that patients will likely be screened for symptoms of COVID-19 before being allowed entry to the office, and testing for COVID-19 may become part of the presurgical laboratory battery. In the interest of minimising need for postoperative follow-up visits, use of minimally invasive glaucoma surgical procedures may increase. Dr Liebmann concluded by urging his colleagues to be encouraged by these challenges rather than discouraged by them. Pointing out that ophthalmologists and ophthalmic researchers are among the most innovative members of the health care community, Dr Liebmann predicted that the solutions that emerge from the ophthalmology community will change medicine forever.

Tags: covid-19 research