To rebuild stronger amid the coronavirus pandemic, more optometrists must provide, and be paid for, medical eye care services. However, becoming a medical care provider takes more than just applying to be on an insurance panel provider list, and it’s a daunting change for some. Services such as Optometric Medical Solutions can help optometrists navigate through the logistics, billing and insurance verification processes.
Beyond the paperwork, ODs will need to stock up on proper personal protection, including effective but reasonably priced masks (check out The Eye Doctor’s Sterileyes anti-bacterial face masks) and slit lamp shields. Medical eye exams are going to look quite different now:
Geographic atrophy. Currently, most cases of geographic atrophy (GA) require low vision specialists to improve vision. ODs should consider referring to a colleague if they don’t offer these services. But if you are looking to help some patients in your office, augmented reality technology (e.g., Eyedaptic) may help the everyday practitioner provide sight to patients who are vision impaired. Therapeutic options are just around the corner with Apellis’s Pegcetacoplan in Phase III FDA trials seeking an indication for GA.
Macular disease. This an essential area of focus in the post-COVID era, considering the many vision-threatening etiologies possible. AMD patients, for example, can’t afford to miss exams, and optometrists are the ideal clinicians for the job. Tools such as dark adaptometry (AdaptDx Pro) with new augmented-reality technology allow for testing in any room—a big help with social distancing. Hand scanners (Pharmanex) serve as an excellent alternative for recording macular carotid levels. At-home monitoring may be even more paramount.
Diabetes. More than 30 million people in the United States have diabetes—and they are at significantly higher risk of morbidity and mortality with COVID-19.1 Monitoring any diabetic retinopathy and glucose stability is critical. Whole-body health, ranging from nutritional supplements to maintaining proper weight and avoidance of smoking, is essential.
Anti-VEGF. As frontline eye care providers, we have to properly set our patients’ expectations, more so now with COVID-19 than ever before. If a patient you refer for anti-VEGF injections isn’t aware of the monthly frequency, they may be surprised and avoid treatment, resulting in permanent vision loss. Fortunately, new knowledge and technology are making things easier. Treat-and-extend protocols are helping, and new therapies require less frequent injections. The Port Delivery System (Genentech) in Phase III clinical testing may reduce follow-up injections to only a couple times per year. Until then, it’s up to us to set proper expectations.
Traumatic brain injury. Some technologies may surprise you, but you shouldn’t dismiss them. I had a highly symptomatic patient who had a severe concussion following a college soccer game more than two months prior to the examination. The student athlete was unable to continue school or soccer.
Although visual field, OCT and other tests were normal (including MRI and other neurologic testing), she had two striking findings.
First, she had a positive but subtle relevant afferent pupillary defect (0.5D). If it wasn’t for the EyeKinetix (Konan Medical) pupil test, I might have missed it.
Second, she reported frequent headaches (three to five per week) since the concussion. Despite trying a number of migraine medications—some with significant side effects—nothing improved. Neurolens (eyeBrain Medical) testing revealed trigeminal dysphoria, esophoria at distance and greater convergence insufficiency at near. Her past vergence testing was normal. After receiving Neurolens glasses, her headaches all but disappeared and she excelled in her December final exams.
Understanding the new normal, new use of technology and adapting to the post-COVID landscape is going to be critical for success. Optometry needs to focus on essential office visits moving forward, and that includes patients with macular disease, diabetes, traumatic brain injury and medical eye care overall.
Note: Dr. Karpecki consults for companies with products and services relevant to this topic.
1. Peters AL. COVID-19 and diabetes: patterns emerge. Medscape Diabetes & Endocrinology. April 11, 2020. [Epub].