How ODs are addressing COVID-19 in their practices

March 18, 2020

By Gretchyn M. Bailey, NCLC, FAAO, Editor in Chief, Content Channel Director

Article

New updates to the novel coronavirus 2019 and associated COVID-19 are coming fast and furious, and healthcare providers-including ODs-may not have a clear understanding of how to apply this information to their pratices.

In the hopes of offering inspiration, we gathered information from ODs around the country on how they are handling COVID-19.

We asked optometrists, including many Optometry Times Editorial Advisory Board members, how their offices are addressing disinfection and potentially sick patients or staff. Their responses are below.

Katherine M. Mastrota, OD, FAAONew York City
Optometry Times Editorial Advisory Board member

Our office does not fit contact lenses, so they are not a concern.

We are:
• Canceling all non-urgent optometry appointments to limit staffing and patients in the medical centers.
• Doctors are working a rotating 12-hour schedule to allow other doctors to stay home and to reduces people in the centers.
• Technician support has likewise been reduced on rotation and overall hours.
• No contact ocular testing unless absolutely necessary that day; this includes gonioscooy, tonometer, and contact pachymetry.
• No non-contact tonometry (NCT), especially for patients with red eyes.
• Patients are asked at the front desk to wash hands or apply hand sanitizer before they enter any examination area.
• Staff wipes down spectacles of presenting patients.
• All slit lamps feature homemade sneeze guards, letter-size.
• All exams are problem focused, so no ancillary testing will be performed unless needed for diagnosis or change in treatment.
• Full exam chair and instrument wipe down with disinfectant wipes (not tiny alcohol preps) between each patient.
• Any patient at risk will be given a face mask to wear.
• Triage stations are located at security as patients enter the facility before they get to optometry. Triage stations are plastic rooms that were build to isolate at risk patients from passing security.
• All clerical staff are reduced to alternating teams to report to work.
• Clinical areas are compressed to reduce travel and staffing throughout facilities.
• Maintenance are full schedule.
• Some specialty services are cancelled.
• Optometrists are selecting which patients must come in.
• All directors appointed three people who could take over if they needed to be out.

James F. Hill III, OD, FAAOCharleston, SCOptometry Times Editorial Advisory Board member

This is what we are doing today at the Medical University of South Carolina, but it is a fluid situation and we receive daily updates.

• Refer all people with mild/ moderate upper respiratory symptoms or concerns of exposure to virtual urgent care. This should be the primary method for triaging patients. Severely ill people should go to the nearest emergency room.
• Care team members who are able to perform their jobs from home should consider that option.
• Practice social distancing (6 feet away from others) at work as much as possible.
• At-risk care team members (>65 years, anyone with chronic conditions, heart, lung, diabetes, immunocompromised, pregnant) should discuss the possibility of remote work.
• Any healthcare worker with exposure or symptoms will be tested; any non-healthcare worker requires exposure and symptoms to be tested.
• At this time, clinics are open as usual. We have plenty of personal protective equipment (PPE) in the eye clinics at MUSC.
• Contact lens policy has not changed. We have stringent hand and equipment sanitizing in place already and have not had to make any additional requirements at this time.

Jim Owen, OD, FAAOEncinitas, CAOptometry Times Editorial Advisory Board member

TLC Laser Eye Centers has sent this information to its affiliated doctors.

As the coronavirus (COVID-19) has become an evolving and uncertain public health issue affecting people globally and close to home, the team at TLC Laser Eye Centers wants to reassure you and your patients health, safety and well-being are of the utmost importance.
We would like to reassure you that our centers are still open and the clinical leadership of TLC Laser Eye Centers are taking several measures to assure you and your patients are safe and protected. The Center for Disease Control (CDC) has set for guidelines to prevent the spread of infection. Our staff at each center are following these guidelines which include:
• Frequent rigorous hand washing by all staff before and after each patient encounter.
• Frequent disinfection of door handles, counters, desks and high traffic areas throughout the day.
• Removal of public convenience items such as water coolers, coffee machines and snacks
• Limit congestion in the waiting room.
• Requiring our employees who are feeling ill, have flu-like symptoms, fever or cough to stay home from work.

As you know laser vision correction is an elective procedure, meaning our patients should be in good health for surgery. In order to protect all patients visiting our offices, please remind the patients you are referring for laser vision correction that absence of flu-like symptoms, fever or contact with infected persons needs to be established prior to their scheduled consultations. We are happy to reschedule their appointment if they are at risk.

Barbara Fluder, ODValdosta, GAOptometry Times Editorial Advisory Board member

• We are keeping the same office hours for now. We are limiting people in the office and rescheduling those who are elderly and need a yearly check-up.
• We have set up a table in front of the office to take peoples temp and ask if they have a cough or shortness of breath.
• We are definitely increasing sanitation and disinfection with spray and wipes. Any person with a red eye is seen in one room near the front of the office. We are using masks and gloves
• We are not changing exam techniques or changing contact lens exams as of yet.

Mile Brujic, OD, FAAOBowling Green, OHOptometry Times Editorial Advisory Board member

These guidelines in our practice are changing hour by hour.

• Currently we are keeping regularly scheduled hours.
• We always practice strict hygiene practices within our offices. We are much more congnizant when these are performed so that patients can see that we are performing appropriate disinfection practices.
• We are educating our patients that if they are not feeling well to postpone their appointments.
• Disinfection practices are always at top of mind. We are much more cognizant of demonstration for the patient of what we are doing to ensure appropriate disinfection practices. We have stopped shaking hands when we walk into the exam room.
• Reassurance is king with contact lens fitting. We have already had several questions in the exam room regarding the safety of wearing contact lenses during this time. We reassure patients that it is safe but to simply remember to practice appropriate hygienic practices whenever handling lenses to optimize the health of lens wear.

Michael Brown, OD, FAAO

Huntsville, AL

Optometry Times Editorial Advisory Board member

At our Veterans Affairs (VA) clinic, we have been told to start cancelling all nonessential care, providing urgent/emergent care only.

Our VA clinic is suspending all elective and ambulatory procedures, including all routine eye exams and most routine surveillance and follow-up visits. We are triaging our schedules for the next few weeks and identifying patients whom we feel must be seen. Even in our high-pathology practice, that list is pretty small. We will maintain a presence-size yet to be determined-for ocular urgencies and emergencies, and of course, to fill Rxs, provide phone and telemedicine consultation, etc.

We are taking these measures in order to provide as-safe-as-possible care to patients who must be seen, protect employees and increase the likelihood they remain healthy and able to provide care both during and after the pandemic, extend our supply of personal protective equipment (PPE), and conserve other resources which will be necessary should the VA be called upon to fulfill its “fourth mission” of providing care for non-veteran civilian patients.

Because I am a federal employee, I can only imagine the stress that private practitioners and other business owners are feeling in this moment. This will stretch and test us, but I am confident ODs and their staffs can meet the challenge. I think the key is balance-recognizing our vital role in the healthcare system and at the same time not thinking more of ourselves than we ought.

Read a story from our March issue: Optometry’s role in multiple sclerosisChris Wroten, ODHammond, LAOptometry Times Editorial Advisory Board member

Our office is not closing, but we have a reduced patient schedule to spread things out.
We are also limiting the number of people in the office at one time (no more than one visitor per patient and only one visitor allowed if critical for the exam, such as parent of minor or interpreter). Plus, we are limiting the number of people in any one area-we removed half the chairs from waiting areas and staging areas.

In addition:
• We sanitize all hard surfaces multiple times throughout the day and providing gloves/masks to all staff who would like them.
• Only optical staff can remove frames from frame boards, and they are sanitizing every handled frame between patients.
• Techs clean all chinrests/forehead rests/patient contact surfaces with 70% alcohol both before and after each patient use; it is cleaned twice before the next patient use.
• We no longer accept visits from pharmaceutical and equipment reps.
• We encourage all staff to employ social distancing and wash hands with soap or hand sanitizer routinely and in between every patient.
• Sign-in sheets are discontinued.
• Techs no longer use occluders; rather we ask patients to cover their eyes with their hands.
• If reception areas start to congest, we ask patients to provide their cell numbers and wait in their vehicles until we are ready for them.

We continue to monitor the situation, and we may eventually reschedule all non-essential visits, especially in the over-age 65 demographic.

Read a story from our March issue: The effect of contoured prism lenses on chronic headaches: a case study

David I. Geffen, OD, FAAOSan DiegoOptometry Times Editorial Advisory Board member

So far we are still open to serve our patients’ needs.

We are:
• Disinfecting all door handles and hard surfaces after every patient encounter. We are disinfecting front desk and dispensing spaces and avoiding patient frame handling and wiping frames down.
• Trying to keep spacing among people.
• Wearing masks and requesting patients to wear a mask, too.
• Remaining more aware of our normal contact lenssterile technique.

Alan Glazier, OD, FAAORockville, MDOptometry Times Editorial Advisory Board member

Our office is not closing or reducing hours, but we are social distancing, wiping things down more frequently, and increasing the use of gloves.

We are changing techniques by distancing in the exam lane, and not performing non-vital services like refractions, and discouraging contact lens fitting at this time.

Read a story from our March issue: New guidelines out for diabetes patient careMike Ware, ODTupelo, MS

We started today in our office with these steps:
• One staffer “policing” the front door.
• Asking patients to wait in their cars until we call them to come in for pretesting.
• Only the patient is allowed to enter the office unless he is a minor and then only one parent may enter.
• Patients picking up contact lenses are asked to call when they drive up, and we will bring them out.

Mark Harder, ODModesto, CA

In our office we:
• Posted signs on the front door warning people to go home if sick.
• Wrote a script about same on phone confirmations.
• Are more aggressive with cleaning, such as pupilometer, waiting room chairs, counters, magazines, and removing clutter that people touch.
• Sending older staff home, making allowances for those staff whose kids no longer have school.
• Space out exam appointments.
• Review options if/when a staff member gets COVID-19.

Read a story from our March issue: Unconventional clinical options for lowering IOP

Craig Steinberg, OD, JDAgoura Hills, CA

I think we have to consider this as a two-way street, meaning not only can we or our staff get an infection from a patient, but we or our staff could give a patient an infection. Unless we have taken “reasonable’ steps to ensure that we and our staff are not infected, we cannot assure patients that we will not infect them. That would create a potential liability risk.

Imagine Ms. Jones, a 74-year-old diabetic, in for her regular fundus evaluation, has drops put in her eye by a staff member who had a sore throat at the time or whose spouse had a sore throat and fever that morning. But you had no policy in place or were not strictly enforcing a policy designed to ensure that your staff did not come in to the office if they had risk, signs, or symptoms of COVID-19. Ms. Jones contracts the illness and dies. The family tracks back her steps and discovers that she was at your office and your staff member tested positive six hours after having seen Ms. Jones.

So, I see at least two concerns:
1. If you have not implemented a strictly enforced policy that keeps at-risk staff away from your office and patients, you have potential legal exposure.
2. If you have not informed your patients (think “informed consent”) that you cannot guarantee that (a) you and your staff, and (b) other patients are not contagious and so they should use their own best judgment as to whether or not to proceed with an eye exam or other services, you have potential legal exposure.

See a story from our March issue: Pediatric headache: The vital role of the optometristLarry Bickford, ODSanta Barbara, CA

My plan is simple:

First, in my “semi-retirement” I am working only two half days each week and have no staff. The other days I go in to the office to do admin work-no patients.

Second, also note that as of this writing there is no confirmed or suspected COVID in our town or anywhere near our town. There is no confirmed influenza and but a handful of “maybes.”

Here is what I am doing:
• Sign on door. But there is always, during influenza season, a sign on my door. I just added COVID info. So nothing much changed there.
• I disinfect every instrument/surface that a patient might come in contact with in the exam room in front of the patient. But I have always done that, so nothing has changed there.
• I wash my hands before and after every patient encounter. I often dry them in front of patient. I have always done that, so nothing new there.
• I wear gloves when touching a patient’s eyelids during slit-lamp examination when there is likely infection and if not, used hand sanitizer before and after the exam. Nothing new there, either.
• I am questioning every patient upon entering the reception room. “Are you feeling perfectly well today? Just in case, I need to know if you have been out of town recently, especially to a place where there are people with COVID or the flu, or around people who might be ill.” OK…That's new.

Read a story from our March issue: Update on iris melanoma

Larry Greidinger, ODLawrenceville, NJ

I am starting to consider closing. The situation is starting to get close to my threshold of comfort.

I think at the rate this thing is growing, it is just a matter of time until I become infected if I continue to see 15 to 20 patients a day. I am also noticing today, for the first time, the cancellations are increasing, so closing the office will soon be a moot point-the patients will cancel me.

I am almost 66 and my wife almost 67. I could not forgive myself if I brought this home.

I am also thinking about my staff and their children and parents, along with not spreading it to my patients, many who are in the highest risk groups. Now, President Trump is saying groups of 10 or less...staff plus a family could be 10.

Clsoing is going to hurt financially, but may be eased a bit with help from the state of New Jersey to help pay salaries.

Read a story from our March issue: Use dark adaptation to screen before multifocal IOL implantation

Michael I. Davis, ODEldersburg, MD

I do not understand the reducing the hours theory. Do only infected people come in after 6 p.m.?

I am attempting to see only patients who have a problem that need solving, such as pathology, broken glasses, or blurry vision. If there is no chief complaint, we can reschedule that.

Lisa Heuer, ODWoodland, CA

We followed the California Optometric Association’s guidance to cancel all non-emergency visits for the next two weeks. It was a scramble yesterday afternoon on the phone, but we got it done. I will be in the office for urgent problems.

One employee is here with me, and the other is working on projects from home. Both have been told that I will pay them for these next two weeks, and they will have my full support if they develop any symptoms.

Anyone who comes in the office gets a squirt of hand sanitizer and a temperature reading with a no-touch thermometer. We are conducting extra sanitizing for all high-touch areas. I expect traffic in the office will be very light.

I desperately hoping that it really is just a two-week pause. I am very skeptical of that, but I am trying to remain positive for my team. A former mentor used to say during stressful situations, “Control the controllables.” I gave the same pep talk to my team yesterday.

Read a story from our March issue: New-onset, atypical retinopathy in a patient with diabetes