Caring for dry eye patients through the coronavirus pandemic

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Special to Ophthalmology Times®

These are challenging times for all of us. As a physician with offices in New Jersey and Pennsylvania, we had to close our practice and surgery center early on.

Most of our staff has been furloughed. I am still seeing urgent and emergent situations (although those have been relatively few). However, we are now offering telemedicine consultations on a regular basis.

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My technician contacts dry eye patients whose appointments were either cancelled during the shutdown or are upcoming to offer a telemedicine option via Zoom videoconference.

The response has been positive:

In one day, I had 11 telemedicine consultations. The focus of the “visit” is a bit less about the physical exam (since our abilities there are limited) and more about symptoms and compliance with their treatment regimen.

Patients have been appreciative of our telehealth services.

Here are three key lessons from this experience so far:

1. There are a lot of compliance issues

In talking with patients one on one, I’m discovering that they are doing a lot of things wrong, such as taking their omega-3 fatty acid supplements erratically or forgetting to take them with a meal.

They may be using their dry eye drops (Restasis, Allergan; Cequa, Sun Ophthalmics; or Xiidra, Novartis) once per day or on an “as needed” basis rather than twice daily as prescribed.

People only absorb a fraction of what we say during an in-person office exam, so I’m realizing that we need to give instructions in many different formats: in writing with pictures or images, and underscore key messages more often-perhaps, even after patients leave the office, as follow-up, touch-base reinforcements.

Also by Dr. Matossian: It takes a village to care for dry eye patients

Unfortunately, for many patients, binge-watching streaming TV and spending a lot of time on their devices at home is likely worsening their dry eye symptoms and meibomian gland disease.

In these symptom-driven consultations, I’ve been able to educate patients about the importance of taking screen breaks and staying compliant with their prescribed treatments.

When they are able to return to the office, I’ll be able to image their glands with meibography.

2. Patients’ disease state comprehension is worse than I thought

One of the reasons that patients may be noncompliant is that they don’t understand the reasons behind what was prescribed. I am taking the opportunity, during these Zoom calls, to reset expectations for the future.

For example, I spoke to a patient recently who mistakenly thought that one thermal pulsation treatment (LipiFlow, Johnson & Johnson) would fix her problems forever because, “My glands have been ‘cleaned out’ now, right?”

We talked about how she sees her dental hygienist twice a year, and that, in a similar fashion, we have to continue to maintain lid and meibomian gland health over time.

3. I love what I do

We all tend to get caught up in the daily grind of our busy lives. But suddenly, being cut off from normal practice, has made me truly appreciate how much I love ophthalmology.

I miss the daily patient interaction, seeing colleagues at professional conferences, and the ability to perform procedures and use all the powerful diagnostic tools we have at our disposal.

I believe there will be some lasting effects of this crisis, both good and bad. We will make changes to office cleaning protocols and likely reconfigure reception and dilation areas to provide more space between patients, even after the risk of transmission of this particular virus has lessened.

Related: AAO webinar offers latest information on patient care amid COVID-19

We hope to incorporate some aspects of telemedicine by phone-to shorten patients’ time filling forms-and review their past medical history or their current medications in the office.

I’m already thinking about promotions we can run-both to jump-start the practice once we reopen and to show patients we are empathetic and compassionate about their financial difficulties and want to help them despite those challenges.

How are you dealing with the coronavirus crisis, and what changes will you make to your practice moving forward?

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