Stripped-back care in Dutch ophthalmology

Eye care in The Netherlands is focusing on acute and semi-acute cases

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BJ Klevering MD, PhD
BJ Klevering MD, PhD, told EuroTimes how the COVID-19 pandemic is affecting ophthalmology in The Netherlands and shared his thoughts about the future. Dr Klevering is Chairman, Dutch Ophthalmic Society (NOG), and Professor and Chairman, Department of Ophthalmology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. How is the pandemic affecting ophthalmologists in their daily practices? Throughout the country, eye care has been stripped down to providing care for acute and semi-acute cases. We are also seeing patients who need to return for intravitreal injections. In tertiary centres like the Radboud Medical Center in Nijmegen where I work, we are still managing to take care of retinal detachments, severe glaucoma cases, ocular trauma patients and other emergency cases, and we intend to keep doing this as long as possible. Patients with an ophthalmic emergency can still receive care at the usual centres. Currently, there is a very real danger in certain hospitals in the southern part of The Netherlands (Noord-Brabant) that ophthalmologists are going to be used for tasks that they have not trained for and are ill prepared for, such as for duty in the coronavirus wards. This is a great concern because of the potential risk to the patient, but also to the doctor. At the moment I have not received any signals from the hospitals that our ability to provide acute and semi-acute eye care, including intravitreal injections, is at risk. What are your concerns about the impact on patients who may not be able to get in for their appointments? All ophthalmologists are very carefully reviewing existing appointments and implementing strategies to deliver care. Depending on the case, this may involve rescheduling the visit to a future date or changing to a telephone consultation. Some patients still need to come to the hospital to be seen in person, and that is still possible. Care of patients who are in retirement homes is a real concern because those facilities are under lock-down. I fear that the consequences will be grave for some patients who have been receiving intravitreal injections for management of a sight-threatening condition. I am also worried about patients who do not have a diagnosed eye disease and develop an emergent condition, such as retinal detachment. I anticipate that some patients may not contact their family physician because of the coronavirus crisis. Consequently, their condition will not be diagnosed until a much later stage. What is the future of Dutch ophthalmology after COVID-19? A lot of eye care is being pushed to a future date. This pool of patients has to be drained someday, and the task will fall on professionals who will probably be truly exhausted by that time. That worries me. What is the future for research and training? It will take some time to pick up where we have left off. We will lose some time, but I am sure we will also gain new insights and experiences from this crisis in our daily clinical work. What are you telling your trainees? Our trainees are fully involved in the daily processes of the current situation, including shifting appointments, doing triages and also performing administrative tasks for other personnel who are no longer able to work. Of course, regular training, such as cataract surgery, is not possible at the moment, but everyone understands the necessity of focusing on essential ophthalmic care right now. We are all working shoulder to shoulder at the moment and feel that we are part of the same team. In that regard, the coronavirus crisis has brought us some good.