- Safety and finances are top concerns among patients returning to ophthalmology clinics.
- Studies suggest SARS-CoV-2 can be found in tears, with or without ocular symptoms, which can lead to possible transmission.
- Seniors may still opt for premium IOLs, while younger patients’ demand for premium procedures like LASIK might decrease.
As coronavirus restrictions begin to ease worldwide, ophthalmologists are reopening their practices. And although shelter-in-place measures have been largely relaxed, new COVID-19 cases and deaths continue to mount.
However, we can’t stay at home forever (or until a vaccine is developed). Therefore ophthalmologists like Dr. Francis Mah — an advanced corneal, cataract and refractive surgeon from La Jolla, California, USA — are making safety their main priority. CAKE magazine CEO and Publisher Matt Young caught up with Dr. Mah at the recent American Society of Cataract and Refractive Surgery (ASCRS 2020) Virtual Annual Meeting to discuss new safety measures, as well as how the pandemic’s impacted finances and premium services.
Surgical Volumes Hit Rock Bottom
No doubt, ophthalmologists around the world have seen their surgical volumes drop significantly. Dr. Mah said that for one solid month, his volume dropped between 1 and 5%. His clinic is now open and operating at a reduced capacity.
“We opened up at theoretically 50% . . . but there was no way I was close to 50%. Probably closer to 25%,” said Dr. Mah.
He attributed the reduced volume to a number of factors. The first? Patients didn’t want to come in. “They might be hesitant to come in and see doctors (in general) for two reasons: One is financial; they don’t want to pay the co-pays,” he explained, adding that currently in the United States, there is record unemployment. “They’re also not working, so are patients going to come in every three months for a pressure check? Or to purchase their medicine? Or anytime they have irritation or changes in vision?
“And the second reason: They are probably going to be scared of other people and there will be social distancing.”
However, missing scheduled visits can result in a minor issue becoming a major, sight-threatening problem. Dr. Mah said that to get these patients back, doctors must demonstrate that the clinic is a safe environment.
Another reason he said that surgical volumes are lower is due to scheduling: “We’re prioritizing patients and limiting the number that we see . . . so we have one patient every half hour.”
Safety Considerations
There are three things to focus on when reopening, said Dr. Mah. “Number one is providing a safe environment for the patients, staff and doctors; then we need to project to the patient that this is a safe environment, so they feel safe and confident.
“Finally, we need to understand all this, and we still need to provide excellent care — that’s the bottom line, right?”
He said that different organizations have provided reopening guidelines, with instructions on scheduling appointments, meeting patients, organizing the waiting room and keeping staff safe.
“One aspect of this is theoretical: What’s the risk to my staff? What’s the risk to me as an ophthalmologist?” he said. “The second is more practical, and has to do with logistics: How do I take that theoretical risk and implement it into my practice?”
To illustrate the risk to ophthalmologists, Dr. Mah points to recent studies regarding the virus’s ocular symptoms. “Some of these studies show — it’s a little bit erratic — but about 1% of people with coronavirus did have ocular symptoms. So, you can’t ignore somebody who calls and says, ‘I’ve got some pink eye, do you think it might be coronavirus?’ It could be,” he said.
Dr. Mah is correct: The study results are a bit erratic, and many with small sample sizes. However, they do illustrate the ocular and COVID-19 connection.
One recent study of 43 participants found that ocular manifestations were rare in their sample of severe COVID-19 patients — however, 7% still had viral RNA in their conjunctival secretions. The authors concluded that there was therefore a possibility of ocular transmission, even in the absence of ocular manifestations.1
Another study with 38 patients — this one from the pandemic’s epicenter in China’s Hubei province — found that one-third of patients with COVID-19 had ocular abnormalities; this was more frequent in severe COVID-19 cases. And although the authors found that there was a low prevalence of SARS-CoV-2 in tears, it is possible to transmit via the eyes.2
“If you have a patient that has coronavirus with eye symptoms, then yes — you could get it from that person’s tears. The eye has a mucous membrane, so you could transmit it that way — although the more likely scenario is going to be from touching, coughing and sneezing,” he said.
A Pause on Premium Procedures?
Patient’s ability to pay will also affect the demand for certain procedures — especially the more premium services or devices. “In the beginning, patients are going to be a little bit wary . . . the pandemic is too fresh in their memory,” he explained.
Dry eye procedures are one example. “A lot of the dry eye procedures are premium, cash procedures. Now, patients may say that ‘I’m going to use artificial tears, warm compresses, baby shampoo, tissues, etc. — then I might think about paying for a more premium procedure,’” explained Dr. Mah.
He continued: “As for cataract surgeries, you’re still going to have the Baby Boomers who are retired and whose finances didn’t really take much of a beating, unlike the working class — those of us under 65 to 70-years-old who are working toward retirement.” He said that Baby Boomers will likely still want premium intraocular lenses (IOLs) and services.
“I think that it will be the younger group that will be more conservative, financially. Those who are 40 to 50-years-old, they might not be coming in for LASIK or LipiFlow as often.”
Editor’s Note: The American Society of Cataract and Refractive Surgery Virtual Annual Meeting (ASCRS 2020) was held on May 16-17. Reporting for this story all took place at ASCRS 2020 Virtual.
References
- Karimi S, Arabi A, Shahraki T, Safi S. Detection of severe acute respiratory syndrome Coronavirus-2 in the tears of patients with Coronavirus disease 2019. Eye (Lond). 2020;1‐4. [Published online ahead of print, 2020 May 18].
- Wu P, Duan F, Luo C, et al. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020;138(5):575‐578. [Published online ahead of print, 2020 Mar 31].
