Full steam ahead as ophthalmic practices adapt to the new normal

As Ireland starts to ease its lockdown measures, ophthalmologists have been rising to the challenge of getting their practices back up and running to deal with patient demand. The Wellington Eye Clinic in Dublin, one of the country’s best-known cataract and refractive surgery practices, has introduced a range of measures to reassure patients and minimise disruption in the wake of the COVID-19 pandemic. Arthur B. Cummings MD, FRCS, Medical Director, and Liz Brennan, Head of Research and Clinical Support, told Eurotimes of the key changes that have been introduced in recent weeks. What is the current situation with your practice at the moment? Are you still seeing patients and if so which ones? We have resumed the majority of appointment types except for contact lens trial appointments. We had virtual consultations and the odd in-person consultation for emergencies during lockdown. We are now back for the past three weeks seeing all patient appointments again and concentrating on new patients or those with ongoing issues. What changes have you made to your daily practice post COVID in terms of social distancing, PPE for staff and patients etc? We removed many of the chairs in our waiting area, added screens to separate patients where chairs are closer, asking all patients to wear masks and put phones in zip lock bags, sanitising station set up at the entrance with a motion sensor “welcome doorbell” that notifies the team that someone has arrived at the sanitising station. The team wash hands between every patient (as per usual) and the clinical team are wearing gloves for clinical exams. All patients attend the assessment station in the hospital assessment area prior to their appointment in our clinic and all staff have their temperature checked twice daily. This is logged on a tracker that also allows us to monitor staff contacts in the event of a requirement to contact trace. We also added a large splash screen at our front desk and smaller screens and breath shields at devices and slit lamps. Floor stickers also give a visual guide to patients and they are instructed to conduct conversations in the consultation room once the doctor/ optometrist is at the sticker (i.e. 2m away) What precautions are you taking to screen patients for COVID-19 before they are allowed to come for a visit? All patients visit an assessment station in the concourse where they are asked a series of questions to check potential exposure/ symptoms and they have their temperature checked. They are given a clearance certificate which they present to us on arrival at reception and this is scanned into their EMR file. They also complete and submit an online COVID-19 form that we send them prior to their appointment where they state the same and digitally sign before submitting. What changes do you expect to make for cleaning of instruments and diagnostic equipment or will you be transitioning to more disposable options? All diagnostic equipment and rooms were deep cleaned each morning as standard pre-COVID and alcohol wipes used between patients. Since reopening, we have increased the frequency of this deep clean throughout the day, ensuring to include phones, keyboards, light switches, door handles and chair armrests as well as the device and equipment tables. Cleaning between patients continues as before. What lessons have you personally learned from the present crisis? It has been a period of adjustment for us as a team. All of our processes have been challenged with COVID but our team came together via Zoom staff meetings to offer their feedback and ideas of how our new process and patient journey would work. Collectively, we designed a new process that aimed to have maximum safety and convenience for the patient while keeping our team safe too. We have introduced online medical history forms and payment links and we are currently reviewing options to allow patients to book their appointments via an automated SMS system. While we are not at the stage yet, I think in time that we will look back on this time as a major challenge for the clinic but one that forced growth that may not have occurred without COVID and which will leave us with a more efficient clinic as a result.