While many eye care practices remain open only for emergent and urgent care, and others slowly reopening with many patients staying at home during the COVID-19 pandemic, providers are exploring alternate ways to maintain the health of patients with chronic conditions such as glaucoma. One intriguing example is drive-through IOP checks.
Geoffrey T. Emerick, MD, told Eyewire News that his partner Michael Koval, MD, introduced this curbside form of care at their practice, Consulting Ophthalmologists, with locations in Farmington and Glastonbury, Connecticut, after hearing about it from Gerami Seitzman, MD, and other colleagues.
“We incorporated many of their ideas,” Dr. Emerick said. “We go through the schedule a couple of weeks in advance and identify appropriate patients. These are typically older patients with a history of stable glaucoma who would prefer to not come into the office, but anyone who needs an IOP check and doesn’t report any change in vision or other complaints is a good candidate.”
The process combines IOP checks with phone calls or video visits. A secretary calls select patients, offers them the option of drive-through service, and explains the logistics. Patients are asked to wear masks and told that only an IOP reading will be performed; discussion will occur later that day during a scheduled phone call.
The practice alerts its landlord and the building’s other tenants about the service and sets up cones around the side of the building. A staff member and signage direct patients where to go: a pop-up canopy big enough to drive through that offers shelter if it is raining and shade if the sun is bright, which could make it harder for patients to keep their eyes open. The practice schedules four to five IOP measurements every 15 minutes for a maximum of 30 patients.
“That’s plenty for one doctor because doing that many phone calls takes at least another 3 hours,” Dr. Emerick said. “By the time the doctor gets back inside the office, the first patients are home, so we’re ready to start calling.”
One of the practice’s writers assists the doctor. The writer has a clipboard with a sheet for each patient that lists his or her name, appointment time, phone number, medications, ocular history, most recent visual acuity, and last IOP reading.
“This helps avoid embarrassments like applanating a prosthetic eye!” Dr. Emerick said. “The patient shows photo ID, and then the IOP is taken. The doctor wears gloves, a mask, and an eye shield. We started with an iCare ic100 tonometer (Icare USA) but found positioning to be an issue, so [we] switched to an ic200, which allows for greater tilting. We have been impressed with the results, which match up with historical Goldmann IOPs and occasional Tono-Pen rechecks at the time of the drive-through.”
According to Dr. Emerick, the reception for this approach to glaucoma care has been amazing.
“It has been a great way to reconnect with patients we may not have seen for a while,” he said. “We get many thanks and comments like “I hope you’re using sunscreen’ and ‘Did you go to medical school in a parking lot?’”
More important, he said, is that they have identified many patients who have required a change in therapy ranging from the addition of topical medication to selective laser trabeculoplasty to urgent surgery.
The practice reopened both of its offices in late May but will maintain the drive-through service.
Dr. Emerick said, “This has been a satisfying and important addition to our care of patients with glaucoma, and we will continue to offer it for the foreseeable future.”