The effect of COVID-19 on ophthalmic practice

A newly designed waiting room with provision for social distancing I do not believe that there is any practice of medicine, including all of ophthalmology, that has not been impacted by the Covid-19 pandemic in some way or another. Practices have been impacted in multiple ways, with clinics being concerned for the health of their staff and patients and then having an equally great concern about the economic challenges that lie ahead. Clinics that have based their revenues on mainly elective procedures have seen their income drop by 99%. Patients are also nervous and are highly unlikely to be queueing up to spend time in densely populated waiting rooms. When the all clear is given to start practising elective medicine again, it's not going to be like a light switch that is switched on but it is going to take time for people to venture out again and seek medical help. The recovery is going to be slow. When people do venture out, however, they are going to be far more inclined to visit a clinic where space is a feature and where high people density is absent. I also predict that patients are going to be more inclined to want their surgeries performed in a day-care centre or even better, an ambulatory surgery centre or clinic, rather than a hospital. Bear in mind that most ophthalmology patients are not unwell and prefer to remain that way. I have been following what is happening in Asia and have been somewhat surprised that refractive surgery has returned at a greater pace than cataract surgery. Once I understood the reasoning, namely that refractive surgery patients are younger and therefore less frightened by the virus, it did make sense. I already see some clinics spending money advertising on how clean, sterile and virus-free their facilities are and believing that this would be a differentiator. In my view, this will not be a differentiator but rather what is called a “hygiene factor”. It goes without saying that you have to offer these infection-control protocols in order to practice safely. This is a time to continue focusing on what really makes you different. If everyone is practising the same level of infection control, then this is clearly not a differentiator. Some of the lessons that I have learned is that the investment that we have made over the years in our team is paying off enormously with the team pulling together, coming up with ideas and plans on how things may look in the “new normal” and generally seeing this significant challenge as an opportunity to do things better after COVID-19 has been beaten, whenever that may be. We certainly foresee a future where telemedicine or digital communication forms a greater part of the routine eye examination experience at the clinic. The history taking and determining of the motivations for surgery would be established remotely with telemedicine, the patient would then be seen at the clinic only to have their scans and the eye examination by the medical team and would then return home again and be followed up with a telemedicine call again to discuss the options and review the exam. This way you are protecting both patient and practitioner with less exposure to one another than before. You are also allowing the clinic to generate the same level of throughput as before, as now patients are physically spending less time in the clinic than before. I imagine that if I were to write about this very topic again in just a few days from now, I will have a different view on certain aspects. That is how fast the impact of this pandemic is impacting clinical practice. Being mentally agile, adaptable, and having a positive attitude and stamina is going to be required to come out the other side looking remotely as healthy as we did just a few months ago, before the pandemic broke.

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