Pandemic Perspectives

Ophthalmologists discuss COVID-19's impact on their practices.

"Every day of my career that I have practiced in the Bronx, N.Y., I have opened the office to see patients along with maybe five to 10 surprise patients per day with eye pressure above 40 mm Hg. I do a tremendous amount of glaucoma surgery, and I am possibly in the top 1% of our country in terms of doing surgery on emergences because I’m in an area that is very endemic. So, I didn’t imagine for a moment that I would stop practicing; however, a couple things happened.
 
First, the pandemic literally struck my practice. Several employees including a physician got COVID-19. Also, it became clear at that point in time in mid-March that the virus was absolutely everywhere. So my practice shut down, forcing the issue out of my hands which in some ways I’m grateful for. 
 
It became clear that there are a number of problems managing glaucoma in this epidemic. The people who are at risk of going blind from glaucoma also have a much higher risk of dying if they get COVID-19. We really realized that if you are bringing a patient into the office in the middle of the pandemic, especially with such a high number of people infected in the population, that you really had to consent the patient. For instance, “If I bring you into the office to check your eyes, you might get the virus or you might give it to someone in your family, or you might give it to someone older than you and that person may die. So before we invite you in to check your pressure today, I need to know if this is worth risking someone’s life.” For almost every case, the answer is going to be “no.” I can understand in some parts of the country where there weren’t so many infected that they wouldn’t have to have such a conversation, but in New York City it was very clear to us that we needed to significantly consider the risk of death and further infection — not to mention the impact of just one person getting the virus on New York as a whole.
 
Last week, I was finally back to seeing patients. There have been a lot of phone calls and a lot of refills called in. I have changed patients’ medicines just out of an abundance of caution over the last month. But we finally feel like things have calmed down. We understand what protocols are needed in the office to safely examine people.
 
One positive of this: I am comforting myself somewhat knowing that I generally treat my patients wanting to be one step ahead of their glaucoma, because life happens. While this is not an anticipated life event, but my general approach is that I want medicines that don’t depend on patients taking drops, I want sustained therapies, laser therapies, early, appropriate and safe surgical interventions. With this approach, some of my patients have been protected by these interventions over the last few years that got them into a better place."
—Nathan Radcliffe, MD

"I closed my private practice for all of March and April, and May may be next on the chopping block. My practice is focused on cataract and refractive surgery, no general ophthalmology. It is purely elective, so it is completely shut down. This is a huge loss, and there is zero income to offset the monthly expenses. 
 
I am still working extensively with our UCLA ophthalmology residents at Olive View UCLA Medical Center, which is a large county hospital. We are treating only emergency and urgent cases (ruptured globe, retinal detachment, acute glaucoma issues, orbital tumor, endophthalmitis, etc.)."
—Uday Devgan, MD 


“We are keeping the prescribed distance between employees and operating with a skeleton crew, not allowing more than a handful of patients in Lehmann Eye Center at any one time and then only necessary surgical follow and urgent care issues. A major undertaking has been calling all patients already scheduled. Most are entirely understanding, though sadly some are not.

All staff have their temperatures checked before entering for work and are allowed to work only if free of any symptoms. Even if they only have minor symptoms, they are sent straight home. All staff are required to wear masks.
 
We question patients about their condition on arrival to LEC and check their temperatures twice before entering, and no family members are allowed with them. Many patients arrive wearing masks, but if they do not, we offer them one. Also, I cannot stress the need for social distancing enough.

At present, we are planning a “soft” reopening of the surgery center and clinic for early May.” 
—Robert Lehmann, MD