Pearls for drawing patients back to your practice

Special to Ophthalmology Times®

Ophthalmology lost a higher share of patient volume than any other specialty during the initial months of the coronavirus disease 2019 (COVID-19) pandemic (March and April 2020).

It is estimated that ophthalmic practice volume fell by 81% during that time frame, led by declines in cataract surgery (97%) and patients seeking care for glaucoma (88%).¹

Related: COVID-19: Practices falling short of pre-pandemic levels

That was certainly true for our practice, Northwest Eye Surgeons. During the 2 months we were closed for everything except urgent and emergent cases, we lost 95% of our normal volume.

The partners worked without pay, and most of our employees, including physicians, were furloughed. The good news is that we have bounced back to nearly 100% of our previous volume. Corneal refractive surgery volume is higher now than at this time last year.

Safety precautions
The most important step in our recovery was a thoughtful, cautious approach to welcoming back patients safely. We ramped up in phases to ensure our protocols were working (and workable).

For example, we added a check-in kiosk, with a masked staff member nearby to help. The staff member takes temperatures, asks screening questions, and escorts the patient to an assigned seat.

Related: Pearls for practicing in the COVID-19 era

These waiting areas have been spread out and numbered, so the staff knows that Mrs Smith is in Seating Area 1. We require patients wear masks, and we even tape them on to ensure they stay properly over the mouth and nose.

Each physician carries a clear shield for the slit lamp and cleans it between patients. I also have implemented a “no talking” rule at the slit lamp. I explain in advance that this measure keeps us both safer. If the patient forgets this rule, I step a few feet away and gently remind them.

All patients undergoing laser or surgical procedures (small incision lenticule extraction [SMILE], laser in situ keratomileusis [LASIK], corneal cross-linking, cataract surgery, or a corneal transplant) are required to get a COVID-19 test within 72 hours before surgery.

We are fortunate in Washington state to get test results within 12 to 24 hours. A negative test result and universal mask wearing were essential to us in offering cross-linking, which is performed in the clinic rather than the ambulatory surgical center (ASC), and is one of the longer procedures we perform.

Related: Slit-lamp breath shields: Larger is better for protection from coronavirus during exams

The pandemic has provided good motivation to sanitize our exam rooms in the clinic even better than we already were; few changes were needed to the sterile environment in our ASC. The biggest change in the ASC has been limiting the number of people in the lunchroom and staff lounge.

Clear messaging
Many patients have asked me, “Should I just wait to have surgery until all this has settled down?” What they are really asking is for us to be clear about the trade-off between risks and rewards.

I tell patients that I do not recommend waiting, for 2 reasons. The first is that the risk of getting COVID-19 during surgery is low. We are experienced in safety protocols and have taken many extra steps to protect patients and ourselves.

We explained all these steps in a video posted on our website.

I tell patients that the ASC is the safest place I go every week.

Related: Surgery during the COVID-19 pandemic: Staying sharp

The second reason not to wait is that there are significant benefits to having surgery. The reality is that “all this” is not going away anytime soon.

Even though many talented people are working diligently on better treatments and vaccines, we will never reach 100% immunity. We will still need to take precautions to protect ourselves and our patients from COVID-19.

Waiting indefinitely to schedule cataract surgery could result in a denser lens and increase the risk of complications. Restoring functional vision is critical for fall prevention and mobility in older adults.²

Postponing cross-linking for progressive keratoconus could be even more damaging if the condition continues and the patient loses vision permanently.

Related: Teleretinal screening fails to do double duty for detecting glaucoma, cataracts


COVID-19 support available
In addition to government programs that helped many practices, like the Paycheck Protection Program loans, the ophthalmic industry has also found creative ways to help practices relaunch successfully.

BVI, for example, just released a line of patient packs to help US ophthalmologists bring back patients to the office and the operating room with confidence. The packs include a face mask, cap, shoe covers and a gown.

Johnson & Johnson Vision is offering a digital toolkit to help ophthalmologists educate patients and navigate a safe reopening.

Glaukos is giving patients vouchers to reduce out-of-pocket costs related to the FDA-approved iLink cross-linking procedure. Through the Living with Keratoconus Patient Support Program, patients with commercial insurance are eligible to get up to $100 toward their nonreimbursable copay expenses for cross-linking procedures completed from mid-June through the end of 2020.

Related: Is the time right for crosslinking?

The company also offers a patient assistance program to support financially eligible, uninsured patients with drug costs at no charge.

Time to reflect
Interestingly, we have seen significant growth in our practice in corneal refractive surgery, which arguably, could be postponed.

Among patients whose disposable income has not been as affected by the pandemic, many are finding that they have the time to research refractive surgery, the desire to prioritize quality-of-life improvements, and the motivation to get rid of glasses that fog up when they wear a mask.

Related: Dispelling myths about refractive lens exchange

Many practices nationwide promote LASIK and SMILE specifically to deal with face mask fog.

Wearing a mask more frequently has spurred some patients to take the plunge—especially if laser surgery was a priority.

Read more COVID-19 and surgery content

About the author

Audrey Talley Rostov, MD
e:atalleyrostov@nweyes.com
Talley Rostov is a partner at Northwest Eye Surgeons in Seattle, Washington, and serves as a board member and medical liaison for SightLife. She is a consultant for Glaukos.

---

References
1. Strata Decision Technology. National patient and procedure volume tracker. Version 5.11.20. Published May 11, 2020. Accessed Month, XX, 2020. https://www.stratadecision.com/national-patient-and-procedure-volume-tracker/

2. Brannan S, Dewar C, Sen J, Clarke D, Marshall T, Murray PI. A prospective study of the rate of falls before and after cataract surgery. Br J Ophthalmol. 2003;87(5):560-562. doi:10.1136/bjo.87.5.560