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Letters to the Editor

Ophthalmology Practice in the UK

Sivaraj, Ramesh FRCSEd, FRCOphth

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Asia-Pacific Journal of Ophthalmology: September-October 2020 - Volume 9 - Issue 5 - p 477
doi: 10.1097/APO.0000000000000318
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To the Editor:

I read with interest the article titled “COVID-19: Special Precautions in Ophthalmic Practice and FAQs on Personal Protection and Mask Selection” by Lam et al1 published in Volume 9, Issue 2 of Asia-Pacific Journal of Ophthalmology. I would like to thank the authors for the very useful information in the article which will help us plan our clinics. The FAQ section was useful in understanding the precautions. We acknowledge that Ophthalmologists are at a higher risk because of the proximity to the patient during the examination.

I would like to share some of our practices in the West Midlands in the United Kingdom. We have adopted practices which have minimized patient contact by conducting screening questions for COVID-19 and obtaining a history through telephone. Patients contact us from the car park when they have arrived. We phone them when they are ready to be seen. We are replacing investigations such as applanation tonometry with i-care rebound tonometry which might be safer. The Royal College of Ophthalmology has issued guidance on patient reviews which gives us a useful framework to plan our clinical work.2 Moorfields Eye Hospital has also developed a protocol for review of patients in the eye clinic during the COVID crisis which help us prioritize patients.3 We have encouraged airflow by keeping windows and doors open and in situations where this is not possible, we have placed a fan behind the clinician to direct the airflow away from them. We have also carried out a risk assessment of staff and provided personal protective equipment to all staff involved in patient care as per Health & Safety Executive.2 We have also adopted Perspex sheets for optical coherence tomography (OCT) machines to minimize the risk of droplet transmission and offer patients masks on arrival in the department. The waiting areas in our department have seats which are placed 2 m apart.4 We conduct all our routine consultations through telephone or video calls. We also have a telephone triage service to decide on urgency of review as the number of face to face clinic appointments is restricted.

We have implemented a virtual follow-up pathway for our wet age related macular degeneration patients who follow the treat and extend protocol and plan to do the same for patients attending for injections for diabetic maculopathy and other vascular causes.5 We also plan to implement a virtual review pathway for diabetic and peripheral retinal lesion reviews using OCT scanner and wide field imaging. We believe this will reduce the risk to our staff and patients who are in the vulnerable group. The COVID pandemic has created a strange reality which is likely to be the norm for the next few years at least. It will be in our best interest to adapt quickly to innovative practices to protect our patients and ourselves.

References

1. Lam DSC, Wong RLM, Lai KHW, et al. COVID-19: special precautions in ophthalmic practice and FAQs on personal protection and mask selection. Asia Pac J Ophthalmol 2020; 9:67–77.
2. The Royal College of Ophthalmology. Glaucoma Management Plans during COVID-19. Available at: https://www.rcophth.ac.uk/wp-content/uploads/2020/03/Glaucoma-Service-Plans-during-COVID-19-270320.pdf.
3. Moorfields Eye Hospital. Moorfields Eye Hospital NHS Foundation Trust-Ophthalmological Risk Stratification & Implementation Guidance. Available at: https://www.rcophth.ac.uk/wp-content/uploads/2020/03/Moorfields-Ophthalmic-Risk-Stratification-Implementation-Guideline-V2.0.pdf. Accessed May 9, 2020.
4. GOV.UK. Guidance COVID-19 personal protective equipment (PPE). Available at: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe. Accessed May 9, 2020.
5. Roach L. Treat-and-extend strategy: is there a consensus? American Academy of Opthamology. 2016. Available at: https://www.aao.org/eyenet/article/treat-extend-strategy-is-there-consensus..
Copyright © 2020 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.