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Glaucoma Fast Facts is a video series designed to provide glaucoma patients and the general public with important information to help understand glaucoma and live with this often "silent" eye disease.
Our first video in the series features glaucoma specialist Andrew Prince, MD discussing "What to Expect on Your Next Eye Doctor Visit During COVID-19. This video series is sponsored by an educational grant from Santen.
Topics discussed in the video include:
Andrew Prince, MD: My name is Andrew Prince, MD. I am a community based glaucoma specialist in upper Manhattan and in the suburbs of northern New Jersey. I also am involved in anterior segment surgery in general including cataract surgery.
Andrew Jackson (Glaucoma Research Foundation): How long have you been practicing?
Andrew Prince, MD: I've been practicing, don't remind me, 30 years.
Andrew Jackson: And what was it that motivated you to become a glaucoma specialist?
Andrew Prince, MD: I was trained at Kings County which is in central Brooklyn and we had a very large African American and Haitian population and we saw so much glaucoma and very severe, very serious glaucoma. And I just saw too many people going blind and I said, "Somebody's got to do a better job at this," and that's what drove me to do it. I just enjoy the challenges of keeping people seeing for their entire lives.
Andrew Jackson: That's wonderful. Now, we're doing this interview because many eye doctors' offices have been closed due to COVID-19 restrictions and are starting to reopen following these temporary closures. And we're going to discuss that in some detail. What can a patient expect to be different on his or her next visit to the eye doctor?
Andrew Prince, MD: Well, I think it would not be unusual for a patient to be interviewed by a physician staff prior to coming in for their appointment basically to make sure that they are not coming in with an active COVID-19 infection. So, we might interview a patient and ask them if they've been exposed to anyone who has an active COVID infection, if they are suspected of having it now and they're in the midst of waiting for a test to come back, if they have any of the typical symptoms of a COVID-19 infection including fever, or shortness of breath, or some impairment of their sense of taste or sense of smell. And if everything seems to be clear at that point then they will keep their visit. They will be coming into the office.
I think once they get to the office... And understand that a lot of this is, I guess the details are specific to every individual physician, and everybody has a little different style. I should add that many physicians would like to interview a patient, certainly new patients, before they come in to limit the 'face time' during their office visit — limit their exposure time to any potential infection either from staff or from the patient. And once the patient comes in they will be interviewed again, just to see how they are feeling and if they have any symptoms, particularly if that phone call was several days before. They may ask a patient to have their temperature taken with a non-contact thermometer. They will probably ask the patients to either wash their hands or scrub their hands with some hand sanitizer before they come in. They will ask a patient to preferably not bring any family members or any aides if they can avoid that. We want to limit the amount of contact for everyone's safety.
Andrew Jackson: And then once they're at the office, I imagine this would change according to the location, but do you think the patient would be asked to wait outside or in their car or in the waiting room?
Andrew Prince, MD: Well, I'm the right person to ask that question to, because I have two practices, one in the middle of Manhattan where there is no parking lot where a patient can wait or a family member can wait with a patient, and in New Jersey where we do have a very large parking lot where we have that option. In the suburbs in my northern Jersey practice, patients do wait in the car, and they contact via cell phone our front desk to see if we're ready for the patient. And then the patient comes, in preferably by themselves, not with any family members or any aides.
In New York it's a little trickier, which is why we try to spread out our visits a little more, because we don't have as much control. Patients are usually not arriving in a car; they're arriving by mass transit and we don't want patients having to wait outside, particularly in the summer, in the heat, to come into the office. And we don't want patients congregating in a waiting room, we want to maintain distance. So, it becomes a little more challenging in these busy metropolitan areas including San Francisco, Chicago, Los Angeles, New York, Boston.
Andrew Jackson: Will patients be required to wear a mask?
Andrew Prince, MD: Every patient has to wear a mask. Don't tell anyone but we have some spare masks if you do forget your mask and we will give it to a patient, but we encourage patients to please have their masks on, and anyone else that's accompanying the patient to have a mask on — and to be worn properly: covering their nose, covering their mouth.
Andrew Jackson: And that would be through the entire visit. Is that correct?
Andrew Prince, MD: Through the entire visit.
Andrew Jackson: And what about conversations? You said some doctors might want to speak in advance by phone. Will conversation be limited during the office visit?
Andrew Prince, MD: We are always trying to limit the contact, the face to face contact in a small examining room where you're at a higher risk of transmitting infection. When we're questioning a patient we want to limit that time and the best way to do that is try to ask the questions while they're home before they come into the office. And as I said the staff might do that or a physician might do that. And once they're sitting at our slit lamp for an examination where our faces are about less than eight inches apart we don't want any conversation either by the physician or by the patient. And don't be surprised if you see a plexiglass shield trying to protect, to keep our faces apart.
Andrew Jackson: Will patients receive a call before their visit to let them know what to expect or should they be calling their eye doctor in advance?
Andrew Prince, MD: We contact our patients and prepare them for what they're going to experience and I think if you don't get that call I think it's wise to call a physician's office and see how you should be prepared and also look at their website. There may be a lot of information on their website explaining what an exam may be like for you.
Andrew Jackson: Now, why are all of these changes taking place?
Andrew Prince, MD: The number one reason is to protect the patient. COVID-19 is a very unique type of infection and can be deadly for a significant percentage of patients, and particularly our population in ophthalmology are older patients and these are the patients that are at higher risk. We want to protect patients, we want to protect staff as much as we can, but still provide the eye care a patient needs. I think if we're taking precautions and making sure the equipment is sterile and patients are wearing masks and keeping distance and not really letting yourself get a busy waiting room, taking away magazines, taking away water coolers and just paying more attention to hygiene, I think it's safe for patients.
Andrew Jackson: Will glaucoma doctors be offering telemedicine visits or tele-health visits by either telephone or video chat?
Andrew Prince, MD: Well, I think they became very popular in the last few months and they can be very helpful even in ophthalmology. There's a limit to how much data we can collect with a video call but certainly listening to the patient and seeing how they appear externally is going to be going to be pretty helpful. And we know that if we have a patient with a red eye which can be a presentation of COVID we prefer not to bring a patient like that into the office and try to treat them just by video conference.
Andrew Jackson: That sounds like a potential scenario where a tele-health visit would be optimal. Are there other such scenarios that would be optimal for telephone or video?
Andrew Prince, MD: I think if you have a patient that has an external disease problem and a skin problem around the eye or an eyelid issue may not need to come in and you can handle that over the phone. I think if a patient is a high risk patient you might try to see if you can get away with a telemedicine visit also.
Andrew Jackson: How could a patient know if their eye health issue needs urgent treatment versus a routine eye checkup? What are some examples?
Andrew Prince, MD: I think any patient who has any pain in an eye or any sudden loss of vision in an eye, any trauma to an eye, has to come in and has to be seen. These are ocular emergencies.
Andrew Jackson: These are a lot of changes happening quite rapidly. What are some of the more positive outcomes for patients that might result from these changes?
Andrew Prince, MD: Well, I think tele-health is going to make some significant advances and become much more popular given what we've been forced to do for the last few months and we might find that patients can't get into an office. There may be a lot that a physician can do for a patient's eye health just with a teleconference.
Last reviewed on July 16, 2020