BLOG: Charting a new course for glaucoma care through COVID-19
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Unforeseen obstacles are an inevitable part of any journey in medicine and in life. Whether we treat them as hurdles or as stepping-stones makes all the difference.
COVID-19 has introduced challenges that few could have predicted. Most ophthalmic practices were initially forced to close for all but urgent or emergent cases. Patients faced canceled or delayed appointments and, subsequently, the anxieties that came with not being able to see their doctors.
These realities were laid bare in the results of a recent Glaucoma Research Foundation (GRF) survey of more than 1,000 glaucoma patients across the U.S. This research, supported by Aerie Pharmaceuticals, was designed to help inform patient care decisions as the pandemic continues to evolve.
According to the results, more than half of patients (53%) surveyed said they had to delay and/or cancel an appointment during the first months of the pandemic. About a third of patients reported feeling “not confident” or only “somewhat confident” in managing their disease during this time. Perhaps not surprisingly, those with the lowest levels of confidence were significantly more likely to have had an appointment delayed or canceled (as compared with those with higher levels of confidence). As we continue to manage through this crisis, it is likely that those patients who have had their visits postponed might need a little more attention.
While telemedicine helped to fill this void for some specialties, it was not widely offered by glaucoma specialists or embraced by their patients, likely given the critical importance of in-person pressure checks. Among patients surveyed, only 4% were offered a virtual visit. Separately, when asked if they would prefer to be seen in person in 6 weeks or by telemedicine in 2 weeks, 87% of survey respondents said they would wait to be seen in person.
These findings highlight just a few reasons why practices must think “outside of the box” and find a way to see glaucoma patients as quickly and safely as possible, taking into consideration their unique resources, facilities, staff and patients, as well as current local infection rates. At our practice in Southern California, access to a parking structure allowed us to create a “drive-through clinic” where patients had their pressures checked without leaving their cars. Those whose results fell outside an acceptable range were scheduled for an in-office follow-up appointment. Those with acceptable results left with peace of mind. We received an overwhelmingly positive response to this approach, including a flood of Yelp reviews by patients who not only praised their experience but encouraged others to schedule and keep their appointments. We were pleased to hear this feedback and to witness patients who didn’t even know one another demonstrate this kind of camaraderie and community support.
While this approach may not work for every practice, consider what else you can do to help manage patients’ disease and ease their minds during this time. For example, another more universally adoptable tactic is to extend prescriptions to 90 days for those whose disease is well controlled. Twenty percent of those surveyed by GRF reported that their doctors used this approach, which can help limit unnecessary appointments for your patients and your practice and have a positive impact both now and in the future.
During the COVID-19 pandemic (and beyond), we will most certainly face more unanticipated challenges. In this (and any) crisis, people will look to those they know and trust for help and guidance. Given the special, often long-term relationship that we glaucoma specialists have with our patients, it is critical that we demonstrate leadership and offer creative solutions that meet the demands of the times, the needs of our patients and the unique circumstances of our practices, while preserving the quality of care we provide. As we experienced at our practice, patients’ reactions will often mirror the examples that we set.
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