In March of last year, the AAO issued a statement urging all ophthalmologists to cease providing any treatment other than urgent or emergent care.

The COVID pandemic has brought unprecedented loss of life and suffering. For much of the world, the last 12 months were filled with stress, loss of routine and forced changes. Ophthalmology and glaucoma in particular have been at the forefront. Chinese ophthalmologist Li Wenliang was among the first to sound the alarm in December 2019, for which he suffered repercussions from the authorities. Tragically in February 2020, he succumbed to COVID-19 contracted from a glaucoma patient.

In 2020, COVID-19 led to more changes in office workflow than had occurred in the prior decade or two. Phone-based preregistration, screening, protective equipment, cleaning regimens, patients waiting in cars, family members excluded from offices, streamlined history-exam-testing and discharge, alternate testing equipment and telemedicine were just some of the areas of profound innovation.

Any ophthalmologists who are practicing the way they were a year ago were either extraordinarily ahead of the curve then or are extraordinarily behind now.

IMPACT ON CARE

The care of glaucoma involves frequent and intensive testing and examination, thus the need for change in the setting of COVID was even more profound. Perimetry was halted early on until sterilization procedures and alternative testing options were identified. Many of us struggled with questions of how telemedicine could help us care for our patients in the absence of an examination and pressure measurement. However, we found that the same detailed history-taking we do in the office often led to meaningful interactions involving changes in vision, difficulties obtaining or using drops and concurrent health issues even in the absence of formal testing or IOP measurement.

Offices adopted new approaches to testing: new technologies, new visit schedules and times, new testing-only visits followed by telemedicine. SLT and depot drugs were advocated to reduce visits. Home IOP and perimetry are now being piloted in many practices.

Office shutdowns and patient cancellations required a rethinking of how to track cancellations and rescheduling while minimizing the risks of patients falling through the cracks. Staff exposures, quarantines and illnesses required flexibility and creativity to keep offices open. Changing guidelines, COVID flare ups, new ideas on protective equipment and precautions and updated local regulations meant that last month’s office protocols often had to be reconsidered and substantially modified.

A SILVER LINING

At the end of this exhausting but occasionally invigorating year, many of us feel we are now providing care that is more patient-centered than it was last year. Office wait times are reduced, testing and care are much more streamlined and individualized and follow-up schedules have been relaxed when possible to minimize additional visits, which many patients have appreciated.

We all hope that COVID is on its way out with vaccinations underway. COVID caused an overwhelming tragedy of suffering and loss but also drove many substantial and perhaps overdue changes in ophthalmology and glaucoma. Hopefully, we will continue to seek radical innovation to improve the care we provide even after the return of normal life. OM

Jonathan S. Myers, MD, is the director of the Wills Eye Hospital Glaucoma Service in Philadelphia, Pa.

Disclosures: Dr. Myers reports relationships with Aerie, Allergan, Avisi, Diopsys, Equinox, Glaukos, Haag Streit, Mati, MicroOptx, Nicox, Olleyes and Santen.