Due to the COVID-19 pandemic, ophthalmologists nationwide transitioned from performing usual services to a limited schedule of urgent and emergent patient visits only. As ophthalmologists continue our mission of protecting sight, telemedicine quickly became a useful method to evaluate patients for many ophthalmic conditions and without a slit-lamp evaluation.
I also recently started performing visual acuity and intraocular pressure (IOP) measurements in the parking lot. This service has proven especially helpful for my patients who are under treatment for glaucoma or are glaucoma suspects. Both telemedicine and parking lot patient evaluations will continue as clinical practices expand patient hours on a regional basis.
Patients are screened prior to a visit for COVID 19 symptoms using CDC guidelines. On arrival, the patient calls the front desk. My ophthalmic technician performs a patient work-up in the parking lot. The patient stays in the car. The patient, family members, and staff wear masks. My tech returns inside and enters the chart visit information — including chief complaint, medical history, medications and compliance — into our EMR (electronic medical record).
I review the chart and meet my patient at their car. Patients who are mobile are asked to stand next to their car (better ergonomics). Elderly patients or patients with mobility issues stay seated. Best corrected visual acuity using a portable eye chart is recorded. For patients who have retina issues or macular degeneration risk factors, Amsler Grid evaluation is performed. In addition, I place an anesthetic drop into each eye and perform IOP measurement with a portable tonopen. I examine both eyes.
I discuss the patient plan with the patient and family members. The plan may include continuing current medications, adding or changing medications, scheduling follow-up studies or procedures. I return inside to complete the patient chart and send medications electronically to the pharmacy. The patient receives a secure email via our patient portal at the end of the day or next morning. As well, my staff mails the patient their visit summary, co-pay receipt, and follow-up appointment date.
Four eye diseases — age-related macular degeneration (AMD), diabetic retinopathy, glaucoma and cataracts — account for most cases of adult blindness and low vision among people in developed countries. Because these eye diseases cause no pain and often have no early symptoms, they do not automatically prompt people to seek medical care.
Glaucoma in particular is a “silent disease.” Patients who have glaucoma are often taking ophthalmic medications to lower their eye pressure. As the COVID-19 social distancing guidelines continue, a parking lot visual acuity and intraocular pressure evaluation offers a convenient opportunity to monitor a patient’s ophthalmic status, optimize medication management, promote compliance and overall eye health.
If you have a sudden loss of vision, trauma, chemical injury or other injury, you should call 911 and go to the nearest emergency room.
The American Academy of Ophthalmology has an excellent coronavirus guide for eye patients here.