After a major pivot to telehealth and a limit to in-office appointments due to the COVID-19 pandemic, doctors have begun to see a decline in glaucoma patients’ health.* “More patients have worse glaucoma than before the pandemic onset,” said Fabian Lerner, MD, professor and head of Ophthalmology at the Fundación para el Estudio del Glaucoma (Foundation for the Study of Glaucoma) at Favaloro University’s School of Medical Sciences in Buenos Aires, Argentina.

Some of the changes that have occurred in ophthalmology clinics include:

• Increased triaging
• Reduction in the number of daily appointments
• Allowing only the patient and/or one caregiver to enter the practice when possible 
• Use of a slit-lamp breath shield, gloves, and personal protective equipment (PPE)

To further understand the status of patient evaluations during the pandemic, Dr. Lerner helped survey 60 ophthalmology leaders. Of these, 47 completed the survey—a response rate of almost 80%. 

The leaders who responded practiced in many countries, such as Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. Survey responses were able to shed light on how the providers are handling the pandemic in their respective countries.

Survey results

Some of the findings from the survey, categorized by general findings and trends in diagnostic methods and treatment methods, include:

General findings

• 74% of physicians did not handle nonophthalmic medical treatments in practice. 
• 87% of respondents are seeing fewer patients during the day.
• 66% measure patients’ temperatures before entering the office.
• 91% require masks to be worn.
• 53% use gloves.
• 87% use PPE.
• 2% examine patients who require emergency care.
• 81% are evaluating every glaucoma type.
• 47% of physicians are using telemedicine to evaluate patients with glaucoma.
• 21% of respondents shared they are seeing the same number of patients; however, 34% of the respondents are seeing half the number of patients compared with before the pandemic. 

Diagnostic method findings

• The use of Goldmann tonometry was reported by 79%.
• The use of Topo-Pen (Reichert Technologies) was used by 21%.
• Rebound tonometry (iCare Finland Oy) was used by 36%.
• Air-puff tonometry was used by 19%. 
• Another unnamed tonometric method was used by 2%.
• Regarding gonioscopy, 66% use it always, 32% use gonioscopy less than before the pandemic, and 6% prefer anterior-segment optical coherence tomography.
• 32% use perimetry less often than before the pandemic.

Treatment findings

• Only 45% of surgeons require that patients have a COVID-19 polymerase chain reaction (PCR) test performed before surgery.
• About a third of surgeons have changed the surgical indications based on challenges with the frequency of controls.

In essence, Dr. Lerner explains the workflow is reduced now, and following the pandemic, longer office hours may be needed to make up for missed engagement with patients during the outbreak. This is confirmed by the finding that more than a third of respondents are seeing half the number of patients than they did pre-pandemic. 

*Charters, L. (2021, Jan. 31). Glaucoma care after COVID-19: The Pan-American view. Ophthalmology Times. https://www.ophthalmologytimes.com/view/glaucoma-care-after-covid-19-the-pan-american-view