Recipe for disaster? Starting out in ophthalmology during the pandemic

During the pandemic, virtual care emerged as a key tool but also served to underscore the importance of teamwork in ophthalmology. (Image Credit: AdobeStock/Zoran Zeremski)

Reviewed by Michelle Khan, MD, FRCSC

When the pandemic hit in March 2020, it was a disruptor to the status quo in ophthalmology and medicine and forced rookie ophthalmologist Michelle Khan, MD, FRCSC, now a consultant at Trillium Health Partners in Toronto and lecturer at the University of Toronto in Canada, to pivot to the changing circumstances.

“It was a very unique time,” said Khan at the Toronto Cataract Course in January 2023 to fellow ophthalmologists, noting that she completed her ophthalmology training at the University of Toronto in the spring of 2019.

“I went to Moorfields (Eye Hospital) in the fall of that year (2019),” she said. “Six months into my oculoplastics fellowship, the pandemic hit— and I found myself at the epicenter of it all.”

Khan noted the UK was one of the countries hardest hit by the pandemic.

“In March of 2020, essentially the government announced a complete shutdown, and the eye hospital was in complete shutdown as well,” said Khan.

Upon returning to Canada, Khan was eager to get involved with ophthalmology care in Toronto and assist in whatever capacity possible.

“In May of 2020, I started to work in clinical practice in Toronto in the West End,” Khan said. “At this time, clinics were completely shut down. At Prism Eye Institute in the west end [of Toronto], we started essentially managing the [emergency] department virtually. We would have about 60 to 70 patients that would virtually enter their information into an online portal. One of 2 doctors would then screen these patients, triage them, and decide based on the history if they needed to be seen urgently or not.”

It was highly challenging to perform in-person examinations, Khan recalled.

“Physical exams were extremely difficult as well,” Khan said. “These things now seem normal, but the wearing of N95 masks, the installation of plexiglass screens, and the limiting of communication with patients during the examination [were] all very, very unique at the time and ... quite constraining.”

Khan was 1 of 2 ophthalmologists who reviewed the electronic medical records, which listed patient symptoms, and then contacted patients to determine if an in-person visit was required.

“The ophthalmologist would screen these patients, call them, and then decide if they needed to be seen in person or if they could be managed medically (without being seen in person),” explained Khan.

Although experience revealed during the initial part of the pandemic that a virtual model of care was not perfect, the model did serve to tier patients by the gravity of their presentation, such that those with the most pressing needs were seen in person, according to Khan.

“In our experience, 15% of about 1500 consults over a 3-month period needed to be seen in person, and only 3% of these [in-person consults] were surgical,” she said.

Khan pointed out that the experience with virtual care emphasized the importance of capturing a detailed history from a patient.

“What I learned was history taking is actually a huge part of our practice,” Khan said. “When in doubt, always examine the patient.”

During the pandemic, virtual care emerged as a key tool but also served to underscore the importance of teamwork in ophthalmology.

“Collaboration with colleagues has been a crucial part of my practice, being able to call my colleagues,” Khan explained. “Anytime you’re concerned about a complicated case, whether it’s anterior segment, cornea, glaucoma, it is about really just connecting with colleagues to make sure you’re comfortable [about a case].”

Because of the initial, complete 2-month shutdown in ophthalmology in Toronto, followed by ophthalmologists operating at 50% capacity in May 2020, wait lists for cataract surgery lengthened, prompting Toronto ophthalmologists to implement innovations to their clinical practice, such as sequential bilateral cataract surgery, Khan noted.

Khan pointed out that the pandemic shaped her education and provided her with a unique surgical experience.

“I found my learning was enhanced and accelerated due to this experience,” she said. “Sequential bilateral surgery allowed me to maximize the number of cases I could complete and to chip away at my wait list. But most importantly, it made me comfortable as a new graduate performing cataract surgery, both routine and complex.”

Another benefit to the pandemic experience was the growth in online learning. Khan under- took a big initiative and organized a series of virtual webinars for ophthalmologists, in which practitioners from around the world could go online to learn from a leader in their field.

“This online setting permits ophthalmologists and surgeons in developing countries, which are not as well resourced, to participate and learn,” Khan concluded.

Michelle Khan, MD, FRCSC
P: 905-848-7100
Khan has no financial disclosures related to the content of this article.

Reference:

1. Jin YP, Canizares M, El-Defrawy S, Bogale W, Buys YM. Use of virtual care in ophthalmology in Ontario, Canada in 2020 during the COVID-19 pandemic. Can J Ophthalmol. Published online October 21, 2022. doi:10.1016/j.jcjo.2022.10.015