Glaucoma Care in the Pandemic

The COVID-19 pandemic has altered life for everyone. It has brought challenges and the repercussions have been felt worldwide. The millions of people infected with the virus has threatened to overwhelm health systems globally.

It has affected a lot of people including health workers, even how people live, work and access healthcare generally. Most individuals now work from home, children school from home, almost everything is done virtually.

Eye Care Services are not left out of the menace that COVID-19 has caused, but eye care givers must adapt.

Methods of handling existing chronic eye health conditions like glaucoma which is actually sight threatening has changed just to ensure there’s preservation of life.

Most patients visiting their eye doctor are now nervous because of the pandemic. However, glaucoma patients should be comforted by the fact that eye doctors, like other health professionals, are already following strict hygiene and disinfection guidelines to ensure their safety.

Ophthalmologists and optometrists have devised various means of taking care of their patients. While the focus during the pandemic for glaucoma patients is to maintain quality access to glaucoma care, patients requiring non-urgent care need not feel left behind, and this is due to the use of telemedicine by clinicians.

Most eye doctors are using telemedicine, which is the use of digital devices like smart phones, computers, etc. for the dissemination of health care products and services. This allows them to communicate and render care to patients far away.

However, glaucoma cannot be effectively diagnosed and managed via Telemedicine, and that’s why in-house appointments in the hospital are highly recommended, especially for patients that have clinically urgent cases.

In this pandemic, glaucoma patients who need to have in-house appointment with their eye doctor are expected to follow some very simple but important guidelines to receive the most adequate care, whilst at the same time preventing the spread of the COVID-19. They should also take note of some changes they’ll meet in the hospital in terms of glaucoma examination.

1. Before entering the Clinic

• Temperature check at the clinic entrance.
• Compulsory use of Face mask.
• Washing of hands with soap and running water.
• Use of Alcohol based hand sanitizer.

2. Reduction of the number of people in the waiting room to avoid over crowding

• Rescheduling patient appointment at specific times will reduce the number of people in the waiting room.
• Patients can be asked to wait in their car instead of the waiting room to avoid overcrowding.
• Patients are asked to avoid visiting the hospital with Family and friends who do not need the services of the doctor.

3. Physical Distance

• Seating areas are redesigned to ensure adequate separation between people.
• one-way system of entry and exit .ie. an entrance Lane and exit lane away from each other so as to avoid Patients passing each other.
• Areas where people queue, boxes created on the floor with tapes should be done.
• Keep people a safe distance apart (1-2 meters)

4. Examination Procedure

• Proper use of personal protective equipment (PPE) by the doctor is recommended.
• Clean and disinfect surfaces like Chairs and arm rest or any areas touched by patients and health workers at regular intervals.
• prop doors if available can be used, so that Patients do not need to touch any door handles.
• Avoid shaking hands, or any other patient Contact, as much as possible.
• Patients are advised to wait until after the examination to discuss with their doctor, so they can talk with them at a safe distance.
• Use of special plastic breath shield on the slit lamp machine and indirect ophthalmoscope. Direct ophthalmoscope should be avoided.
• Recommend that patients and clinicians totally avoid or limit speaking when at the slit lamp.
• Clean and disinfect breath shield and ophthalmic equipment (e.g. slit lamp, tonometer .etc.) after each patient use.
• Keep visual field or OCT scans to an absolute minimum.
• Minimise patient contact time by reviewing notes before time.

One way to do this is by placing the clinician in one room and patient in another room, then after the discussion, clinician and patient can assemble in the examination room for a swift test with minimal speaking.

• Restrict the use of cash, and avoid sharing of personal items such as pens, keyrings, handfans, mobile phones.etc.

REFERENCES

1. Community Eye Health Journal. Volume 33. Number 109. 2020. Pg 10-12.
2. Nigerian Center for Disease Control COVID-19 guidelines

https://COVID-19.ncdc.gov.ng/guideline

3. Parke DW. Ophthalmology after coronavirus disease 2019 (COVID-19): Transition back to patient care. JAMA Ophthalmology. https://doing.org/10.1001/jamaophthalmol.2020.2004
4. Reena Mukamal. Eye Care During the Coronavirus Pandemic (COVID-19). https://www.aao.org/eye-health/tips-prevention/coronavirus-covid19-eye-infection-pinkeye