Have you restarted performing comprehensive eye exams at each injection visit?
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Back to the normal routine
As the COVID pandemic continues to affect our nation and the world, one important question we encounter is: “Should ophthalmologists perform visual acuity testing, slit lamp examination and eye imaging at each injection visit?”
Although each patient encounter takes into account the unique medical circumstance of that individual, asymptomatic patients wearing face masks can be safely examined during their visit to the retina specialist. Ophthalmologists have safely reopened their clinical and surgical practices and have enacted the precautions necessary to protect patients, staff and themselves. With these safety practices in place, it is important to properly assess a patient’s eye health.
Visual acuity, dilated examination of the anterior and posterior segments of the eye, and retinal imaging such as OCT and fluorescein angiogram are essential to determine if a patient’s eye disease is progressing. If the disease is worsening, then more frequent anti-VEGF injections may be recommended. In addition, switching anti-VEGF agents may be necessary if examination and OCT scans show a worsening of retinal edema or subretinal fluid. Furthermore, a comprehensive examination can determine if new vision-threatening conditions (such as drug-related intraocular inflammation, endophthalmitis, retinal tear or retinal detachment) have developed that require urgent intervention.
Certainly, patients receiving intravitreal brolucizumab need careful examination of the eye to determine if inflammation or retinal vasculitis has developed. Patients value their vision more than any other sense, and in order to preserve and improve their vision and vision-related quality of life, ophthalmologists should strongly consider performing a careful examination of the eye with appropriate ocular imaging.
Diana V. Do, MD, is from Byers Eye Institute, Stanford University School of Medicine.
Minimize ancillary testing, focus on what is essential
Many of the patients we treat, as retina specialists, are elderly and often immunocompromised or have other comorbidities that put them at a higher risk for severe illness from COVID-19.
Because many require regular long-term treatment for their eye condition, our goal is to continue to deliver the care they need, making it as safe as we possibly can. To do this, we have to consider ways to streamline the overall treatment process and make visits as safe and efficient as possible.
One approach is to minimize any portion of the visit that is not mandatory. For new patients and patients with an acute problem or worsening of symptoms, a full and thorough visit is needed, including visual acuity measurement, slit lamp examination, OCT and other imaging as needed. But for patients who are known to the clinic who are on a well-established injection routine, it can make sense to streamline the process and minimize the time for the patient in the clinic in order to try to minimize risk for exposure to COVID-19.
In my area, many patients have been hesitant to come to the clinic, and I have found that they feel reassured and are more likely to comply with their treatment schedule if they know their clinic visit is going to be efficient, minimizing any unnecessary testing and focused on getting the necessary treatment and leaving the office as soon as possible. If lengthier visits with full examinations are spaced out, they accept them more easily and with less concern. I also educate my patients to check for vision changes using the Amsler grid at home and promptly contact me if they notice anything. Hopefully, in a not too distant future, home OCT technology will enable us to monitor our patients remotely. The pandemic has made all of us feel the need to accelerate the development of this technology and other improved technologies for remote monitoring.
Charles C. Wykoff, MD, PhD, is from Retina Consultants of Houston.
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