Pearls for handling glaucoma cases amid COVID-19 pandemic

Recommendations and guidance for ophthalmologists regarding COVID-19 are evolving quickly, and updates frequently change from day by day.

Thomas M. Brunner, president and CEO of the Glaucoma Research Foundation (GRF), issued a statement offering tips for ophthalmologists who must continue to work amid the COVID-19 pandemic. In the statement, Brunner shared some frequently asked questions and answers from our glaucoma specialist advisors that may be helpful.

Please also visit the GRF website: www.glaucoma.org for more information about COVID-19 and glaucoma.

Brunner noted that office visits are cancelled unless there are unusual symptoms or an urgent need. “According to the latest information from the American Academy of Ophthalmology, clinicians should postpone those outpatient visits and procedures that can be safely delayed, particularly in elderly patients and those with comorbidities,” Brunner said in the statement. It also is a good idea for patients to have extra medications.

“It’s always good to keep an extra supply of your regular medications in the event of an emergency whether illness, or a pandemic like now,” he said.

Should a patient have to be hospitalized for any reason, having extra medications they can take with them will help them maintain their regular eye care to preserve their vision. Brunner agreed with current positions that elective surgeries should be postponed.

“Where surgery isn’t an emergency or urgently needed it should be postponed for two reasons,” he said. “First, to avoid unnecessary exposure to the coronavirus, and second to preserve scarce supplies and hospital beds for those impacted directly by the pandemic.”

Guidelines help

While the current situation brings great uncertainty, Brunner also noted that following the latest guidelines for preventing disease transmission through isolation and cleanliness is expected to slow and ultimately end the spread of the disease.

Brunner added that officials at the Glaucoma Research Foundation also is practicing social distancing to ensure the safety of its staff.

“The team at GRF is working safely from our homes to continue to advance our mission to cure glaucoma and restore vision through innovative research and to provide information and education about glaucoma,” he said. “Our goal of a world free from glaucoma is as important as ever while we encourage everyone to take all necessary precautions to preserve health and vision in the near term.”

Brunner also noted it is imperative for everyone to take their health and their vision seriously.

“Working together we’ll overcome the current pandemic and together we’ll advance research to cure glaucoma and restore vision,” he said.

The GRF is the latest group to offer advice to its members, following the lead of the American Academy of Ophthalmology, which last week advised its members to immediately stop routine surgical and in-office visits.

“Due to the COVID-19 pandemic, the American Academy of Ophthalmology now finds it essential that all ophthalmologists cease providing any treatment other than urgent or emergent care immediately,” the AAO said in a statement.

ASCRS statement

In a statement on the American Society of Cataract and Refractive Surgery website, ASCRS President Nick Mamalis, MD, noted that ASCRS fully supports the Academy’s position, which is aligned with CDC’s recommendation.

“We concur that even eye exams pose the risk of contagion between asymptomatic patients and medical staff due to our close proximity, and ophthalmologists care for a disproportionately elderly population,” he wrote. “Furthermore, CMS released guidelines citing cataract surgery as an example of elective surgery that can be delayed without harm.”

The recommendation is in effect until further notice.

“None of us could ever imagine a scenario where we might have to limit or cease performing life-changing cataract procedures,” he added. “However, these are exceptional times that require extraordinary measures. It is critical at this time that healthcare professionals in general, and ophthalmologists specifically, come together and unite on guidance and recommendations that will safeguard public health and mitigate the spread of this infectious disease.”

In the statement, Dr. Mamalis acknowledged the hardship that the position can place on ophthalmologists and their patients.

“This is an extremely complex problem we are facing, and we need as a society to put the safety of ourselves, our staff and most importantly our patients, as the highest priority,” he concluded. “With time, commitment and perseverance, we will get through this together.”

Optometric perspective

The American Optometric Association (AOA) released a statement agreeing with the CDC’s stance that ODs should focus on urgent and emergent care to patients.

Based on the immediate health needs of a patient, doctors of optometry can and should use their professional judgment to determine the timing and course of care, including assessing patient expressed urgency, necessary preventative care, and the monitoring and refilling of prescriptions.

However, this does not mean that ODs should close their practices. Offices do not have to close down, says Barbara Horn, OD, president of the AOA. ODs should bring in someone if it is an emergency unless the patient is sick.