Eyeworld Supplements

AUGUST 2020 | SUPPLEMENT TO EYEWORLD | 5 Supported by Alcon Reframing clinic flow in the age of social distancing I t goes without saying that there has been significant trial and error with clin- ical protocols during the COVID-19 pandemic. Since the moratorium on elective care was lifted, we have steadily reinstated clinic vol- ume and are now seeing about 80–90% of the pre-pandemic volume. My cataract surgical vol- ume is about 90% of pre-pan- demic levels. The adoption rate to advanced technologies in my practice has been rela- tively stable, with about 40% of new patients adopting ad- vanced technology IOLs. I've had a small percentage of pa- tients who could not adopt an advanced technology IOL due to the economic changes of the pandemic. This has been offset by patients who were increasingly frustrated by the constraints of their declining, suboptimal vision and have the financial means to opt for more spectacle freedom. At this time, social dis- tancing and patient protection are our main goals, and how to accommodate this while increasing clinic volume is challenging. Additionally, we are trying to accommodate by Elizabeth Yeu, MD continued on page 6 continued from page 4 I'm now devoting one full day to a telehealth-only clinic. Hybrid televisits have been a game changer for us. We've designed a workflow where patients come in for a very targeted, focused exam. We contact them later with the results and discuss the plan virtually. This strategy keeps our staff employed and keeps necessary patients minimally exposed. It is also helpful for the post-COVID return-to-work backlog. Using hybrid visits, we're able to see patients in multiple locations on the same day. Our patients can now choose their most convenient location and have a visit within a more efficient timeframe, instead of having to wait for the limited days per month that we visit that location. Lately, we've been using a video slit lamp adapter that al- lows the remote staffer to see the entire exam. This adapter was relatively inexpensive and has been a big help in our emergency room and during hybrid visits. There is also a drone slit lamp, which is technology that enables the patient to sit at a slit lamp that a doctor logs into remotely. They are able to see the images and control the slit lamp from any location. For helping patients decide whether they should go to the ER or not during the pandemic, our urgent care telehealth clinic has been su- premely helpful. We were able to triage patients and help roughly 70% of them virtually, while expediting patients who did need to come in. We were also able to identify those who needed immediate help who might not have sought it in time were it not for telehealth. One such visit involved a patient who seemed unable to see things on her left side during a virtual Amsler grid test. She was asked to come in immediately and an acute stroke was identified. That telehealth visit may have saved her life. Telehealth in ophthalmol- ogy, a specialty so dependent on high-quality imaging and in-person testing for diagnos- tics, does require a change in thinking about how to help patients. I've found you can learn a lot about what's going on just by talking to the pa- tient and by observing. That's more what telehealth is about. It's more about triaging pa- tients; it's more about counsel- ing patients than doing every single element on the exam. This is like a Renaissance age for medicine. It's going to change the way we care for patients from here forward. Editors' note: Dr. Habash is the medical director of technology innovation and an assistant professor of ophthalmology at Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida. "Telehealth in ophthalmology, a specialty so dependent on high-quality imaging and in- person testing for diagnostics, does require a change in thinking about how to help patients." —Ranya Habash, MD

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