Adapting Glaucoma Care During the COVID-19 Pandemic

Just over a year ago, even as we read of cases being reported from every continent, little did we realise then, that we were dealing with a disease that would soon become a pandemic. Singapore was one of the first few countries outside of China to have confirmed cases of Covid-19. It is difficult to comprehend the impact and challenges that we were forced to grapple with, in our personal and professional lives.

Given the evolving and uncertain nature of the pandemic, the processes and operations at the hospital were also changing rapidly from one day to the next. We promptly adapted our practices to ensure that we continued to provide the best care to our patients. In terms of clinical practice, although we never really had to shut down our out-patient clinics, for about 2-3 months the numbers were down to about 15-20% of the usual patient load. Several of the staff including doctors, nurses and allied health professionals were re-rostered to other areas of need. The pandemic also impacted clinical research; patient recruitment was suspended for several months.

While the pandemic has created a global crises of unimaginable extent, there has also been some positive impact, one of which is the embracing of technological applications in patient care. Social distancing and partial lockdown measures enforced during the pandemic compelled hospitals to augment the use of technology. We were able to remotely access and review patients’ electronic health record and make decisions. This helped us stratify patients and identify those suitable for deferral or follow-up visits. It was however a challenging and arduous task, due to the lack of a validated risk stratification model for glaucoma. We have also started exploring the feasibility of ‘virtual consultation’ clinics and have stepped-up referrals to our Glaucoma Observation Clinics (for glaucoma suspects and stable glaucoma patients), which is aimed at reducing the patients’ time spent in hospital premises, and to also decongest glaucoma clinics. Additionally, a ‘Free Medication Delivery Service’ was initiated by the pharmacy department to further minimize the time spent in the hospital.

The Covid-19 situation has necessitated a range of responses that will likely drive refinements in our approach towards glaucoma care. Soon, we envisage an accelerated development and adoption of new digital technologies leading to digital transformation in healthcare, including strategies to better assess risk, and to transform glaucoma management for improved patient outcomes.