COVID-19 and Eye Care

Bhubaneswar: COVID-19 pandemic threw a challenge at healthcare which unfortunately did not have precedence. The consequence was unimaginable fear of losing near and dear ones among people, chaos in the healthcare delivery system, and lack of consensus to prevent the spread of the virus infection.

An ophthalmologist in Wuhan, China reported atypical pneumonia in
late Dec 2019. Within a short span of three months, COVID 19 had spread its deathly tentacles over large swathes of geography across continents. In a few months, COVID-19 was declared a pandemic.

Today as we look back at the delivery of eye care services before and after the pandemic,
we might be surprised to find that several novel approaches to eye care delivery emerged amidst the most trying circumstances mankind has faced in recent times. Interestingly, all of these approaches were known before the pandemic. However, they were limited in their reach because of gaps in technology, awareness, and availability of user-friendly platforms.

• Teleophthalmology:  in simple words, this is the remote delivery of eye
  care services with the help of telephones. Before the pandemic, telemedicine-
  teleophthalmology was limited to sporadic pockets. Few patients and even care
  providers believed in its reach and many thought it was contradictory to the very
  essence of health care delivery where a patient and doctor sit across each other. The two key measures to control the spread of COVID 19 – universal face masks and social distancing, made physical examinations of patients a major challenge. In eye care delivery systems, a doctor needs to examine the patient’s eyes at close
  quarters (6 inches) to diagnose and treat the eye disease. It is not surprising that
  early reports of the transmission patterns of COVID 19 showed high risk to eye
  doctors. Within the LVPEI network, the teleophthalmology platform underwent
  serial generational changes within a short span of time. What started between early March and April 2019 as mere telephone call by our eye doctors to find how their most vulnerable patients were managing their eye problems, quickly transformed into calls made via an in-house teleophthalmology application – ConnectCare that allowed the eye doctors a glimpse of the medical records from a remote location. The app was an interface for the electronic medical record of a patient and the online consult. This made clinical decision-making easier for the eye doctor and the online prescription that was dated and signed could be sent to the patient’s phone. The latest version of the ConnectCare app that’s currently in use allows the eye doctor to connect through a video call and most patients are happy to be able to talk to their doctors from the safe confines of their home. One can safely say that teleophthalmology platforms like ConnectCare provided a continuity of care for patients who had had one physical eye examination in the recent past. They also helped decongest eye hospitals thus allowing those in need of emergency care to make a physical visit to the eye care center. Done well, teleophthalmology and physical examination can be balanced for efficient delivery of eye care. Till date, as many as 55,000 teleconsults have been made at LVPEI and 20,000 consults on ConnectCare. In the not-so-distant future, we may have patients who underwent cataract surgeries by  sending high-resolution self-
  taken pictures of their eye to their doctors from the confines of their home. Their glasses would then be delivered home.

• Home Care: We as children have either heard from parents or grandparents about
  the family physician who was only one phone call away. In a lighter vein, some of us may recollect a movie where the family physician makes an appearance just in time to save a human life. Unfortunately, a family physician like the omnipresent sparrow has vanished into thin air. The mushrooming of specialist and super-specialty centers possibly made the lives of family physicians difficult. COVID-19 heralded the renaissance of the home care delivery model. Several factors may have been responsible for this welcomed change – better technology (smartphones), improvised imaging systems, travel restrictions and the need to deliver care to the elderly or home-bound patients who were at a high risk of COVID 19. LVPEI launched HomeCare that includes a home visit by the team who would record vision with a pair of corrective glasses where needed and take pictures of the patients’ eyes and retina. This information helps an eye doctor who does a video call with the patient on ConnectCare the next day and gives an impression if the disease is stable/better or has progressed necessitating physical examination. Again done well, HomeCare has the potential to reach out to whom access to health care may have become most difficult in recent times.

• Emergency Eye Care: COVID-19 made access to emergency eye care difficult.
  Patients with eye cancer need early treatment to salvage vision, eyes and even life.
  Fortunately, even during the strictest lockdown protocols cancer care was made
  available to patients of LVPEI throughout the year. This was managed by our staff who were able to fast-track emergency passes for eye cancer patients and family.
  Retinopathy of prematurity is a sight-threatening disorder of premature babies who must undergo screening and those with the active disease must be treated urgently. Again through the year our ROP team continued screening of at-risk premature babies and delivering necessary care.

• Surgery protocols: Eye surgery in COVID times had its own share of challenges.
  Multiple layers of safety protocols were put in place. Patients who were
  scheduled for aerosol-generating procedure went through antigen testing (Rapid
  antigen test and RT PCR) to mitigate the risk of transmission. In an analysis done at LVPEI, we found our staff absenteeism rate was always below 20% thus allowing near-normal clinical care. In summary, COVID-19 will be remembered for a long time. In the most trying circumstances, several innovative eye care delivery systems helped eye care reach the masses. Most of these systems will continue even after the COVID-19 pandemic. Like in life, a balance between these new innovative eye care delivery systems and conventional physical eye examination offers the best hope to all.