A Message from
Rishi P. Singh
The COVID-19 Pandemic - In times of despair opportunities abound
Reading the news and listening to reports of friends and loved ones being affected by the pandemic can be concerning. The calls from local and national health authorities to stay apart to stop the spread while trying to maintain a normal lifestyle can be difficult. And then seeing stories of patients young and old losing their lives to this virus can make us feel defeated and lost.
Unlike the last excepts from near and far, I'm here to tell you about the opportunities that are evolving even during this time of despair. Some of them have come from the federal stimulus package and government response while other efforts have come as a result of innovation and have from physicians like you that question the norm. Let's explore all of these in more detail.
1. We are changing our patient exams.
How did we decide on our current post-op regimens? Mainly because someone, likely your mentor, examined patients day 1, week 1, and month 1. There is now lots of evidence that post-op day 0 appointments are reasonable and reduces additional exposure for the patient and even post-op day 1 appointments aren't necessary. A study in 2015 in Eye found that the intervention rate on the first day after vitrectomy is low and day-1 postoperative review can be safely omitted in the majority of patients undergoing vitrectomy. So in the time of this pandemic, we are asking ourselves whether another appointment is truly necessary.
Ditto with imaging tests. Why are we getting bilateral tests on patients each time if the disease we are treating is only present in one eye? Is that OCT going to change our plan if the patient has stable vision with a long interval of treat and extend interval? Likely not. Don't get me wrong, diagnostics tests are necessary for the new patients without a diagnosis but the use of monthly or ongoing imaging strategies is something we are exploring with this pandemic.
And what if we skip an injection in a patient with DME and good vision (20/40 or better)? A study we just conducted showed that an unintended lapse in follow up for 3 months had no gross impact on final vision outcomes when compared to those following up regularly.
2. We are expanding the boundaries of virtual visits.
Ophthalmology has been slow to explore these due to the lack of technological solutions. With the federal stimulus package legislation, a relaxation of the HIPPA rules followed allowing us to care for patients through apps like FaceTime and Google Duo making Telehealth possible for all - something that should have happened years ago. And for the patients with simple anterior segment complaints, this can be a very effective option.
I've used this to connect with patients face to face and determine if a visit was necessary. Examples include patients referred for s second opinion when I had the imaging in my EMR, PVD follow-ups without any visual complaints, or a diabetic without previous retinopathy or visual complaints who were returning for their annual exam. We've asked our patients to use app-based vision exams to test their vision.
With the coming advent of home OCT, you can imagine even a more expanded virtual visit base of patients that we can care for especially in times like this. And the archaic rules that govern our ability to care for patients across state lines have been relaxed so I can help those in need. Through this experience, we will realize which virtual technologies are needed and spur innovation to get them into clinical practice sooner
3. We are still working and going to be busier than ever once this passes.
Elective surgery has been postponed until this passes. However, we are still addressing the leading causes of blindness during the pandemic because we cannot delay the treatment of age-related macular degeneration, retinal detachments, endophthalmitis, and diabetic retinopathy. While many practices around us have closed temporarily, it allows our practice to shine and take care of patients in need. And when the quarantines are lifted, we will come out of them with more patients than ever needing our medical and surgical abilities. Finally, by chance hydroxychloroquine and chloroquine become the standard of prophylaxis for the condition, our retinal abilities will be needed to screen these patients.
So fear the pandemic, maintain social distancing, and wash your hands frequently. But also remember that in the process we are changing how the practice of retina will happen for now and likely the future for the better.
Rishi P. Singh, MD