There’s no playbook for the pandemic but these three considerations will help: (1) protect your practice from both a health and liability perspective; (2) adapt with hybrid strategies for medical eye care; and (3) focus on patient-pay procedures.

Protect Your Practice

You have to keep you, your staff and your patients healthy—and protect the practice from a liability perspective. Even when we have a vaccine, the protocols now in place will continue for some time:

  • Use gloves, masks and proper PPE, and make sure patients are all wearing masks.
  • Wear scrubs you can remove at the end of the day and take a hot shower before settling in at home.
  • Check temperatures before patients enter the office, have them complete a COVID-19 symptom questionnaire and ensure proper social distancing between patients.
  • Assume every patient could be a carrier and try to limit time within 24 inches of the patient to about a minute; discussions can take place from at least two feet away.1

Not only do these steps protect everyone, they also show that you care about the patient’s health.

Richard Hom, OD, Gregory Moore, OD, and, now, Fadi Al Akrass, MD, a top infectious disease expert, have weekly webinars that provide updates on everything from the vaccine pipeline to patient flow ( In one episode, they interviewed an attorney who noted that patients cannot sue a practice for getting COVID-19 unless they can prove negligence. Currently, every positive test requires that patients provide a list of places they have visited days before symptoms began or testing was positive. If a certain optometrist’s office crops up often, the health department may intervene and consider the practice negligent. In addition, new laws allow insurance companies to forego paying if the doctor is found negligent.

To help ODs avoid accusations of negligence, Drs. Hom and Moore provide a regularly updated workbook with standard operating procedures for COVID-19 patient care, checklists and the latest research behind those recommendations.

Adapting Medical Eye Care

Although most practices, like mine, are seeing fewer patients per day, we are making up for it in efficiency and more hybrid examination options. For example, if, during the exam, I determine a patient requires dilation (and it’s not a high-risk situation, such as a retinal detachment), we reschedule them for a follow-up visit. In cases of glaucoma, the patient may come in only for OCT or visual fields and then go over the results and next steps via telemedicine. Our one-month moderate-to-severe dry eye follow-ups, provided the patients are not using topical corticosteroids, are conducted via telemedicine as well.

Patient-pay Options

Many practices have survived COVID-19 by focusing on patient-pay procedures. While most patients with vision plans delayed their yearly eye exams, patients with medical ocular conditions did not. In fact, many who missed exams during the shutdown are more willing to have in-office procedures, including thermal pulsation, Blephex and intense pulsed light/low-level light therapy (LLLT). Our LLLT procedure volume is up over 400%—perhaps because mask-wearing patients are developing far more hordeola and chalazia. Other patient-pay options like

Neurolens (eyeBrain Medical) have also increased for us substantially. Patients may be saving more money, using their stimulus checks or are more aware of ocular symptoms while at home on digital devices.

It’s not too late to implement these changes or enhance what you are doing. The private equity–owned Keplr Vision, with more than 350 medically focused optometry practices, is a great example. They are seeing their highest revenue per practice to date. Going medical, offering patient-pay procedures, embracing technology, taking precautions and lowering liability risk are keys to your COVID-19 game plan.

Note: Dr. Karpecki consults for companies with products and services relevant to this topic.

1. Lai X, Wang M, Qin C, et al. Coronavirus Disease 2019 (COVID-2019) Infection Among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China. JAMA May 21, 2020. [Epub ahead of print].