For optometrists, opticians and other eye care providers, COVID-19 came in like a wrecking ball — smashing through previously held beliefs and business strategies.
Depending on geographic location, optometrists and other eye care professionals have had different experiences during the pandemic. Some countries locked down quickly and effectively, and now, enjoy a relative return to normality. On the other hand, countries that did not lockdown or impose strong restrictions, continue to see increased COVID-19 infections.
However, even in countries that enjoy a relatively COVID-19-free existence (like Vietnam and New Zealand, for example), the “rules” of optometric practice and education have still been fundamentally impacted.
Patient behavior has changed; even in “safe” countries, those who are immuno-compromised or elderly may not be as keen to seek out vision care. Plus, patients will need additional reassurance that all safety measures are followed.
Costs have gone up for practitioners, too. Due to safety and social distancing regulations, there are fewer patient appointments. Plus, procuring PPE, disinfectant and other supplies to ensure safety all have a price — and surely, many clinics lost revenue when they closed during lockdowns.
But in the debris of what was, a new normal is slowly taking shape. And in this period of uncertainty and change, one thing is certain — flexibility is key, and the necessity and ability to adapt to ever-changing circumstances has become remarkably clear.
Virtual Insight from Thailand
One notable change is the acceptance of telehealth systems. More, now than ever, patients and physicians alike are embracing digital technology to pre-screen, monitor and educate patients. Annual meetings and conferences have also gone virtual, which has allowed learning and information sharing to continue at a global level. This includes the Asia Optometry Conference (eAOC 2020 Virtual), which was held in November 2020.
One of the conference’s presenters was Danai Tonkerdmongkol, O.D., who discussed optometry’s response to COVID-19 in his home country of Thailand.
“In the beginning [of the pandemic], there was a lot of confusion … there was a lot of panic and rumors as usual,” began Dr. Tonkerdmongkol. He said that although there was evidence that COVID-19 arrived in Thailand in December 2019, the government was slow to take action.
Then on March 17, the Thai government closed its borders — like many other countries worldwide. At this point, all health care services were deferred, unless they were COVID-19-related or life-threatening emergencies.
To help, the Association of Thai Optometrists worked with the Ministry of Public Health throughout the COVID-19 pandemic to issue guidelines and screening protocols for opticians, optometrists and eye care providers.
“In the beginning, the cases were not that widespread and we thought that there was not much of a problem in the general population,” continued Dr. Tonkerdmongkol. This from December 2019 to March 2020, when COVID-19 was just getting its bearings in Thailand.
“After the government announced an emergency situation, the Association quickly responded with recommendations for optical and optometry practices that could still maintain public functions,” he said. By the end of April, Dr. Tonkerdmongkol said that the situation had improved, with cases dropping to less than 100 per day. By May, new cases were nearly non-existent.
“During that time, the Association consulted with virologists and epidemiologists to design more comprehensive solutions and publish the New Normal Optometric Care Standard for Prevention of COVID-19,” said Dr. Tonkerdmongkol, adding that they continue to use this standard-of-care today which is based on all they’ve learned throughout the pandemic. “Of course, we would like to share this with everyone.”
Enhanced Safety Measures Remain Critical
Kristie Nguyen, O.D. is an optometrist in Florida, USA. Currently, the United States leads the world in COVID-19 infections and deaths. To continue operations, enhanced safety measures have been instituted throughout the entire patient process, from check-in to check-up.
Today, many of these precautions are common in optometry offices everywhere: In the waiting room, there are fewer seats to allow for social distancing; accompanying family members are limited; and if possible, only the patient is allowed in the examination room. These combined efforts aim to reduce exposure, shared Dr. Nguyen.
Masks are, of course, a requirement. However, although they help reduce the spread of COVID-19, they can cause hassle in the exam room. “There are a lot of steamed lenses during refractions, slit lamp evaluations and dilated fundus exams. This is because the masks are not fully airtight,” she explained.
Further, Dr. Nguyen said they’ve increased their PPE supplies and of course, thoroughly disinfect everything between patients. “We’ve installed extra shields for slit lamp evaluations and dividers to protect our front staff from patient interactions when they enter the office,” said Dr. Nguyen. “Plus, temperatures are screened for each patient.”
As noted above, the added cost of PPE and the lower number of patients has affected the clinic’s bottom line. But as they say, “when one door closes, another opens.” As such is the way in today’s world. Dr. Nguyen said they’ve used this opportunity to opt for more retinal imaging to avoid close contact while examining the posterior segment. They have also embraced online registration to reduce time spent in the office filling out paperwork.
“We are also moving toward more digital efficiency,” she added.
Long-Term Impacts for Eye Care Professionals
While everyone is doing their best, these extra precautions coupled with patients’ unwillingness to come into the office for treatment, means that some conditions are getting progressively worse.
This was noted by one study out of Singapore.1 Although the authors expressed worry about ophthalmic resources being overstretched as restrictions ease and patients return, they were more concerned with vision implications. “More sobering is the real possibility that some patients may suffer permanent vision loss because they were unable to receive timely care during this pandemic,” noted Khor et al.
The next generation of eye care professionals are also taking a big hit: “Residents and fellows have suffered in all aspects of their training, including disruptions to formal didactic teaching, a lack of clinical exposure, and a drastic reduction in surgical numbers,” stated Khor et al.
The authors note that other than COVID-related projects, almost all other research activities have been suspended — this will negatively impact ongoing eye studies and trials, and has given rise to worries about retaining researchers and staff as research funds inevitably run dry.
The Mental Burden of COVID-19
COVID-19 has affected just about everything, from increased safety precautions and digital platforms, to clinic closures and the halting of research … the list goes on. So, it’s no wonder that mental health is affected, too.
According to Khanna et al., there is already much data on the impact on health professionals in China: One study reported that among medical and nursing staff in Wuhan, 36.9% had subthreshold mental health disturbances; including 6.2% that were severe.2
Therefore, to take a deeper look at the psychosocial impacts of COVID-19 in India, Khanna et al., surveyed 2,355 ophthalmologists and ophthalmologists-in-training in 10 states.
“To a question on the effect of COVID-19 on their training or professional work, 1,244 (52.8%) felt that COVID-19 would have a considerable or serious effect on their training or profession. Regarding financial implications, 869 (37%) had difficulty in meeting their living expenses,” stated the study’s authors.
Further, they found that 765 (32.6%) had some degree of depression: mild 504 (21.4%); moderate 163 (6.9%); and severe 101 (4.3%). “This was much higher than the 10% prevalence for common mental disorders reported from the general population in India,” Khanna et al. noted somberly.
Numerous factors influence this high level of depression: a generalized pervading climate of uncertainty among the ophthalmologists, triggered by the limitations in training and job security; fear of COVID-19 and its severe symptoms in some individuals; lack of availability of PPE and of adequate care in hospitals; and a shortage of ventilators and intensive care unit beds if someone were to contract the disease. Respondents were also concerned with bringing the infection home to vulnerable family members.
The study also noted that there is an “anticipated decrease in footfalls for availing eye care services, so there is likely to be a sense of [financial] insecurity among these ophthalmologists.”
And although today, much uncertainty still remains — there is hope. Several vaccines are now in-use and in-development with varying degrees of efficacy; and as more of the world’s population is vaccinated, we should slowly see lessening restrictions. Will the world ever return to the pre-pandemic normal? This writer thinks not — but is optimistic that brighter days are indeed ahead for eye care professionals in Asia-Pacific, and for people the world over.
- Khor WB, Yip L, Zhao P, et al. Evolving Practice Patterns in Singapore’s Public Sector Ophthalmology Centers During the COVID-19 Pandemic. Asia Pac J Ophthalmol (Phila). 2020;9(4): 285-290.
- Khanna RC, Honavar, SG, Metla AL,et al. Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India. Indian J Ophthalmol. 2020; 68(6): 994–998.