Eyewire News checked in with four retina specialists in COVID-19 hotspots around the United States—Seattle, New York, Boston, and Orlando—to see how they are adjusting their clinics in light of the AAO’s latest guidance. To read a full summary of their adjustments, read the forthcoming April issue of Retina Today, which will cover COVID-19 in retina.
Yewlin Chee, MD, University of Washington School of Medicine, Seattle
The AAO has also advised against performing nonurgent surgical procedures. Which types of surgical cases do you consider nonurgent?
The University of Washington has a moratorium in place on nonurgent surgeries through mid-May. The cases that remain on my schedule include rhegmatogenous retinal detachments and secondary vitrectomies after open globe injuries. Macular holes (particularly if they are longstanding), diabetic vitreous hemorrhage without additional macular-threatening pathology, membrane peels for epiretinal membranes or vitreomacular traction, silicone oil removal, and dislocated lens cases are nonurgent and can be rescheduled.
There are exceptions, however. Consider a scenario in which a monocular patient needs surgery that would allow him or her to perform the activities of daily living. In these situations, I think the case can be made to take the patient to the OR.
Thanos Papakostas, MD, Assistant Professor of Ophthalmology, Weill Cornell Medical College, New York
The AAO has advised that retina specialists only offer urgent and emergent in-office care. Where do you draw the line between urgent and nonurgent in-office care?
The cases that need to be seen are anything involving acute vision loss and acute eye pain. Regarding injections, I try to extend the interval in as many patients as I can; I continue to administer injections to patients on monthly therapy. Unfortunately, patients with AMD are vulnerable patients who, should they get COVID-19, have the highest chance for admission to ICU and mortality.
Before an appointment, I have a phone call with the patient in which I discuss the pros and cons of a visit, and a decision to proceed is made on a case-by-case basis. Postoperative patients are also seen in the clinic. There is a telemedicine initiative in our facility that works nicely for other ophthalmic subspecialties and medical specialties. For our field, given the nature of the exam and practice, telemedicine consultations are limited in general.
John B. Miller, MD, Assistant Professor of Ophthalmology, Harvard Medical School, Boston
What precautions are you taking in your clinic to protect your patients?
We have significantly reduced appointments all clinics since March 16. Visits have been limited to postoperative evaluations, anti-VEGF injections, and urgent evaluations for events such as retinal detachment, PDR, and ruptured globes. All staff are required to wear surgical masks, and patients wear masks for injections (which was common practice for some physicians prior to the COVID-19 outbreak). We are also spreading out schedules to minimize the number of patients in the waiting room.
S.K. Steven Houston III, MD, Florida Retina Institute, Orlando
What personal precautions are you taking to protect yourself as a physician?
All of our clinical staff wear surgical masks and gloves, and maintain strict hand hygiene measures, equipment cleaning, and high-touch point cleaning.
We have installed plastic shield barriers on slit-lamps. However, I minimize my use of the slit-lamp in favor of indirect ophthalmoscopy. Our practice approaches all patients as if they are asymptomatic COVID-19 positive. Per guidelines, I am wearing a surgical mask (preferably a N95 mask), eye protection (goggles/safety glasses), and gloves. These personal protective equipment (PPE) recommendations enhance the safety of the clinic for patients, staff, and physicians.
If a patient that visited our clinic reports symptoms and tests positive for COVID-19, the department of public health contacts the patient and find out where he or she was during the past week. If a physician or staff member wasn’t wearing appropriate PPE, then that physician or staff member will be sent home for self-quarantine for 2 weeks or until a negative test is confirmed, which can take 5 to 10 days to turn around.