(Part 2) From ophthalmology’s lockdown to lasting change: The pandemic habits that stuck

From the upheaval of lockdown to the innovations that endured—ophthalmology’s journey from past to present continues to shape its future.(Image credit: AdobeStock/MarekPhotoDesign.com)

Half a decade after COVID-19 reshaped the landscape of health care, ophthalmology practices are still adapting—not out of crisis, but through continuous innovation and resilience. A key consideration now is which adaptations have endured, and which have been left behind. Understanding how patient behavior and expectations have shifted in this post-COVID landscape remains essential, prompting ongoing refinements in care delivery and operational strategy.

In Part 1 of this series, we spoke with a geographically diverse group of clinicians—including members of the Ophthalmology Times Editorial Advisory Board and Strategic Alliance Content Partners—about how those early days shaped their practice, priorities, and perspective.

For Part 2, we return to the same group to explore what has endured. What innovations or shifts have stood the test of time—and what can ophthalmology carry forward to meet the next challenge with renewed clarity?

“When flu season comes around in my part of the country each year, my hope and expectation is that patients and staff will be more cognizant of the need for masks, good hand hygiene, and other appropriate behavior and practices to limit spread,” said Peter J. McDonnell, MD, the director and William Holland Wilmer Professor of Ophthalmology at the Wilmer Eye Institute at the Johns Hopkins University School of Medicine in Baltimore, Maryland, and co-chief medical editor of Ophthalmology Times.

Peter J. McDonnell, MD

With a recent bump in the number of people with respiratory illnesses in his region of the country, the use of masks in patient care areas has appropriately returned, he said.

“But we are back to “business as usual” in terms of caring for all who seek to come to us, whether they suffer from a serious urgent problem or just need new glasses, and providing as comfortable and patient-friendly an experience as possible,” McDonnell noted.

“I have since changed practices from 2020,” said Nicole Bajic, MD, director of communications at the Cole Eye Institute, and assistant professor of ophthalmology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, “but I would say one of the persistent vestiges from the pandemic would be adjustment of certain practice patterns from prior to the pandemic, especially in regard to how often we may be seeing certain patients. In terms of postoperative care, I no longer see patients for their second eye’s first postoperative week if they had routine phacoemulsification with no MIGS.”

"In terms of postoperative care, I no longer see patients for their second eye’s first postoperative week if they had routine phacoemulsification with no MIGS.' —Nicole Bajic, MD

Though many aspects of patient care have returned to pre-pandemic routines, some changes introduced during that time have remained or have been newly adopted in response to the challenges of the pandemic period.

“The use of virtual reality visual field testing has become a big part of our practice along with Humphrey visual field (HVF),” said Oluwatosin “Tosin” Smith, MD, attending physician and surgeon, Glaucoma Associates of Texas in Dallas.

Oluwatosin “Tosin” Smith, MD

Testing-only visits are still provided as an option to patients. Certain practices like the use of a slit lamp shield or use of a mask is optional but available. Ninety-day medication refills and autorefill are also recommended and are a good way of making sure patient stay adherent but reduce interaction with their pharmacy, she added.

“The experience of COVID has helped us to understand how we should be prepared and react in the face of another pandemic,” Smith said.

Some health systems have made some long-term changes based of our COVID models. In the UK, they have transitioned into some of the hybrid visit models with patients with more stable chronic eye conditions to relieve the gridlock in their health system.

“Having an emergency fund for the practice was another thing we have done,” Smith continued. “Transitioning into using technology more in patient communications is something we have introduced as well to ease communication in the event of future emergencies.”

David A. Eichenbaum, MD, director of research with Retina Vitreous Associates of Florida in Clearwater and St. Petersburg, expressed that the biggest lasting change since the pandemic is the ease and prevalence of virtual meetings.

“Our clinic has not evolved because of the pandemic, but our overall workstream and efficiency has improved dramatically." —David A. Eichenbaum, MD

“Our clinic has not evolved because of the pandemic, but our overall workstream and efficiency has improved dramatically,” he said. “We are busier with Zoom [calls] nearly every day, but we are much more productive. From both a practice and a worldwide specialty perspective, our field is much more connected in real time.”

John Berdahl, MD, with Vance Thompson Vision in Sioux Falls, South Dakota, reflecting on the transformative changes of 2020, said they have retained many adaptations that have permanently reshaped their practice.

“One significant shift is our commitment to ensuring that every patient visit is impactful—not merely focusing on eye care, but on the overall well-being of the individual,” he said. “We have reformed our appointment system to ensure that each interaction is meaningful, addressing not only clinical needs but also emotional and holistic health aspects.

John Berdahl, MD

“Conversely, we have phased out practices that were reactive responses to the crisis but are no longer sustainable in a post-pandemic environment,” Berdahl said. “Patient expectations have evolved, with a greater emphasis on clear communication and a personalized approach to care. In response, our practice has embraced these changes by fostering a more patient-centered culture, ensuring that every encounter is both effective and compassionate. This ongoing evolution underscores our commitment to doing what is best for the person as a whole, reinforcing the principle that impactful care extends well beyond treating the eye.”

“Many adaptations from 2020 are now permanent in my practice,” said Ehsan Sadri, MD, chief executive officer and founder of Visionary Eye Institute in Newport Beach, California.

Telemedicine remains a viable option for follow-ups and initial assessments, offering patients flexibility. Enhanced hygiene protocols and PPE use continue to mitigate infection risks. As conditions improved, certain restrictive measures, like limiting patient volume, were adjusted to meet increased demand, he said.

“Patients now expect flexible consultation options and stringent hygiene practices, prompting the practice to uphold these standards,” Sadri added.

James C. Tsai, MD, MBA, president, New York Eye and Ear Infirmary of Mount Sinai; Delafield-Rodgers Professor and Chair, Department of Ophthalmology; Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, agreed.

“Since 2020, we are utilizing big data and global communication tools to enhance our clinical practice,” Tsai said.

There is a greater emphasis on sterile processing of instruments and equipment to make the patient care environment safe for patients and healthcare professionals, he added.

“An emphasis on constant handwashing is tantamount to this safety focus,” Tsai said.

Preparing for the future

Reflecting on the COVID-19 pandemic, many ophthalmologists have gained insights that could help the field better prepare for future health crises. Lessons learned—from adapting clinical workflows to prioritizing patient and staff safety—can serve as a valuable guide for navigating future disruptions. There is also a growing call for the profession to evolve in ways that enhance resilience, whether through technological innovation, more flexible care models, or stronger integration with public health systems. As health care providers, ophthalmologists are well positioned to play a proactive role in future public health efforts, both within their practices and in the broader medical community.

As McDonnell reflected, “Having started my residency just as one pandemic was underway (subsequently identified as HIV) and having practiced while other pandemics have popped up (Swine flu, SARS, COVID-19), my opinion is that it is not a question of whether there will be new pandemics down the road but rather when these will occur.

“We, of course, know that the warning regarding the most recent pandemic came from an ophthalmologist, Dr. Li Wenliang. Sadly, his warning was not heeded, and he was punished for alerting his medical school classmates. Tragically, he himself reportedly died from COVID,” McDonnell said.

Whether it would have made a difference if authorities had acted promptly upon receiving Dr. Li’s report is probably unknown, McDonnell continued, but his story makes clear: a) the opportunity for ophthalmologists to have an impact by observing and reporting the emergence of such diseases in their patient populations and b) the risk ophthalmologists incur of themselves contracting respiratory illnesses by virtue of the close proximity of our “ocular workplace” to the mouth and nose and their virus-containing secretions.

“Those who are wise, I believe, will maintain stocks of personal protective equipment, sanitizers and associated supplies so that they can protect themselves and their staffs when the next pandemic rears its head,” McDonnell said.

“We learned to better identify which types of visits can be remote and also risk stratify different visit types based on urgency,” Bajic said.

RELATED: When the world went virtual: How ophthalmology’s conferences stayed on track

Smith noted it is “important to have gone through the pandemic to see the gaps we have in the care we provide.

“Being able to monitor patients outside of the office—especially IOP and visual field—is something we could look toward in the future,” she said. “There are now devices available (not currently approved in the US) that measure 24-hour IOP at home providing critical information to clinicians. These advances will help in the face of a future pandemic.

“Expanding the use / ability of technology in patient communication is happening all around us and would also be helpful in a future event as it relates to patient facing side of care,” Smith continued.

Many patients showed up with worsening in their chronic disease just because of being lost to follow up. “If we transition now, patients and caregivers will be accustomed to using technology as it evolves,” she explained. Since 2020, telemedicine visits have become more common used in some areas of the medical field where it’s amenable.

“Having an emergency practice plan in place may be a good idea to have guidance for the future while it’s all still fresh in our memory,” Smith added. “There was a lot of confusion and stress during that period as we worked through next steps and best practices for our practices and staff. Thankfully, this occurrence doesn’t happen often, and we hope to be better prepared next time.”

Eichenbaum urged that ophthalmology needs to be ready to embrace uncertainty but be brave in the face of public health crises.

“Patients do not stop developing wet [age-related] macular degeneration or retinal detachments because there is a viral outbreak.” —David A. Eichenbaum, MD

“Patients do not stop developing wet [age-related] macular degeneration or retinal detachments because there is a viral outbreak,” Eichenbaum said. “The field can take the most important teachings of the pandemic—that we adapted rapidly with simple measures such as PPE and deprioritizing routine visits, and the outbreak passed—and remember that when the next public health crisis appears.”

Berdahl agreed that he lessons learned from the COVID-19 pandemic are invaluable for preparing for future health crises. “One key takeaway is the importance of recognizing and planning for Black Swan events—those rare, high-impact occurrences that test the resilience of any system,” he said.

Inspired by Nassim Taleb’s concept of being “antifragile,” we have restructured our organization to not just endure shocks but to grow stronger in their wake. This involves implementing flexible protocols, continuous staff training, and robust contingency plans that allow us to pivot quickly in response to unexpected challenges, Berdahl explained.

“I would advise fellow ophthalmologists to prioritize the creation of resilient, adaptable practices that can safeguard both patient care and staff well-being,” Berdahl added.

For Sadri, “starting a new practice before a global health crisis taught me invaluable lessons in adaptability and preparedness.”

Key takeaways include the need for robust telemedicine infrastructure, flexible operational protocols, and comprehensive emergency response plans. The field of ophthalmology should invest in training programs that equip practitioners with skills in virtual care and crisis management. Additionally, ophthalmologists can play a vital role in public health by engaging in community education, supporting vaccination efforts, and collaborating with health authorities during future health crises, Sadri said.

Tsai advised that in order to prepare for future health crises, “ophthalmologists must continue to refine our ability and capacity to perform virtual eye exams.

“For example, our department has employed a teleophthalmology triage system for two of our hospitals that do not have in-person ophthalmic coverage in the emergency department,” Tsai said.

In preparation for another global health event, the field of ophthalmology should embrace “lean” strategies and strive to reduce patient waiting time and waste. Ophthalmologist can contribute to public health efforts in the face of future pandemics by creating patient care environments that are more efficient and patient centric, he added.

Perspectives from academia

Academic institutions and training programs faced unique challenges during the pandemic, prompting rapid adaptation to ensure continuity in education and hands-on training for residents and fellows. These experiences have since shaped how academic programs approach preparedness, flexibility, and innovation in ophthalmology education. The expanded use of telemedicine and remote learning has not only bridged gaps during the crisis but also introduced lasting changes that continue to redefine how future ophthalmologists are trained, emphasizing adaptability, digital fluency, and new models of clinical engagement.

“Our trainees acted admirably and courageously during the most recent pandemic,” McDonnell said. “While many patients with non-urgent issues delayed their care, patients with emergencies came to our institution, especially as most private clinics in our state closed or markedly limited their hours, and the patients with emergent problems presented to receive the care they needed.

“This experience convinced me that better technologies are required to provide the detailed imaging that needed to make informed diagnoses and guide appropriate therapies." —Peter J. McDonnell, MD

“In our state, the suspension of care for ‘routine’ problems, such as a cataract surgery, resulted in a temporary decrease in the numbers of cataract surgeries and other less time-sensitive therapies by our residents in order to allow the PPE and other resources to be directed toward life-saving care of patients in our intensive care units (our hospital received the bulk of severely ill patients in our state),” he added. “But our residents still very much mastered the skills required to become accomplished clinicians and surgeons and I believe the experience will prepare them for when the next such challenge appears.

“Many departments in my medical school were able to largely transition to telemedicine. We in ophthalmology, however, saw many patients during the pandemic who presented to our emergency room with eye problems after having been ‘diagnosed and treated’ elsewhere remotely a couple of days earlier with telemedicine (pretty much this consisted of a FaceTime discussion or something similar), only to fail to respond to therapy for the diagnosis or conjunctivitis or episcleritis and be found in our emergency room to actually have uveitis or other condition,” McDonnell noted. “This experience convinced me that better technologies are required to provide the detailed imaging that needed to make informed diagnoses and guide appropriate therapies. Our faculty are working diligently on technologies that will allow accurate at-home monitoring of intraocular pressure, the taking of “retinal selfies” and similar strategies to permit remote assessments of ophthalmic patients without the compromises we saw during the pandemic.”

Nicole Bajic, MD

Bajic added that “the pandemic highlighted the importance of being flexible and making adjustments as necessary to ensure things are as balanced as possible.”

Remote learning has allowed for trainees to attend lectures and conferences virtually when offsite, which has only enhanced the educational experience, she noted.

Academic institutions faced the challenge of ensuring continuity in education and training for residents and fellows, and faculty alike, during the pandemic.

Sadri noted that the integration of telemedicine and remote learning became essential, with virtual lectures, webinars, and tele-supervision becoming commonplace.

“These adaptations have reshaped the academic landscape, highlighting the value of flexible learning environments and the need for curricula that incorporate telehealth competencies,” he said. “Moving forward, academic programs are likely to continue utilizing these tools, preparing future ophthalmologists for a more versatile practice environment.”

The integration of telemedicine and remote learning have created new opportunities for ophthalmic education to have significant impacts around the world, according to Tsai.

“For example, I was honored in 2024 to give a virtual lecture on glaucoma diagnosis and management to the All India Ophthalmological Society International MasterClass from the comfort of my own home office,” Tsai said.