Glaucoma care after COVID-19: The Pan-American view

This article was Reviewed by S. Fabian Lerner, MD

The coronavirus disease 2019 (COVID-19) pandemic has changed worldwide medical care dramatically.

Outcomes associated with every aspect of the virus — such as the endpoint of the pandemic, mortality and morbidity, vaccine efficacy and duration, economic impact, psychological consequences, and the impact on the health care system as a whole and glaucoma care specifically — remain uncertain.

Recommendations for continuing care of patients in a general ophthalmology setting include triaging, reducing the number of daily appointments, allowing only the patient and/or 1 caregiver to enter the practice when possible, and using a slit-lamp breath shield, gloves, and personal protective equipment (PPE), according to S. Fabian Lerner, MD, professor and head of Ophthalmology at the University Favaloro, School of Medical Sciences, Fundación para el Estudio del Glaucoma in Buenos Aires, Argentina.

Specifically for glaucoma, Dr. Lerner cited concerns expressed about which tonometers, gonioscopic lenses, and perimeters are the safest; in addition, some surgical procedures may require more examinations than others.

LAGS survey
To gather information to evaluate the status of patient evaluations, a survey was sent in December to the members of the Latin American Glaucoma Society (LAGS).

Sixty key opinion leaders (KOLs) from Latin America were contacted and of these, 47 ophthalmologists completed the survey for a response rate of 78.3%.

The responders represented practices in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. The responses were able to shed light on how the group of responders are handling the pandemic in their countries.

Here are the highlights:

• A question about the need to fulfill nonophthalmic medical treatments in practice indicated that 74% of physicians did not.
  
• Most responders (87%) are seeing fewer patients during the day, 66% measure patients’ temperatures before entering the office, 91% require masks to be worn, 53% use gloves, 87% use PPE, 2% examine patients who require emergency care, and 81% are evaluating every glaucoma type.
  
• Telemedicine is used by 47% of physicians to evaluate patients with glaucoma.
  
• The use of Goldmann tonometry was reported by 79%, Topo-Pen (Reichert Technologies) by 21%, rebound tonometry (iCare Finland Oy) by 36%, air-puff tonometry by 19%, and another tonometric method by 2%.
  
• Regarding gonioscopy, 66% use it as always, 32% use gonioscopy less than before the pandemic onset, and 6% prefer anterior-segment optical coherence tomography.
  
• Responses about perimetry showed that 32% use perimetry less often than before the pandemic.
  
• The responses indicated that 43% of patients presented with more glaucomatous damage than before the pandemic.
  
• Regarding the numbers of patients evaluated, 21% reported seeing the same number of patients; however, 34% of the responders are seeing half the number of patients compared with before the pandemic.
  
• Only 45% of surgeons require that patients have a COVID-19 polymerase chain reaction (PCR) test performed preoperatively.
  
• About a third of surgeons (36%) have changed the surgical indications based on difficulties with the frequency of controls.

“Generally, the work flow is less now and following the pandemic longer office hours may be needed,” Lerner said. “Most physicians are triaging. About 50% use telemedicine to evaluate patients.”

Lerner concluded that many physicians are now using other tonometers, such as the Tonopen or rebound tonometry; and a third each use less gonioscopy and perimetry.

“More patients have worse glaucoma than before the pandemic onset,” he said. “About 45% of surgeons require a preoperative PCR test, and 35% have changed surgical indications based on less frequent controls.”

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S. Fabian Lerner, MD
E: glaucomas@yahoo.com.ar
Dr. Lerner is a consultant to Alcon, Allergan, Glaukos, Iridex, and Sidus.