The world as we know it, has changed over the last few weeks. It is only natural that so will your interaction with your glaucoma doctor. Some of these changes will be uncomfortable, some expensive, and some painful. All of these changes, without doubt, will make sure you are safer than ever before. So here is what you need to know about your glaucoma consult in the Covid 19 era.
Teleconsult
Social distancing is the new normal. Therefore, it may be better to first consult with your doctor online, or over the phone. Depending on the need, she may decide to defer a face to face consult, or ask you to visit the hospital. For now, most routine visits are being deferred. Only patients with advanced or uncontrolled glaucoma are being asked to come to the hospital.
Waiting to see the doctor
Before you step inside the hospital, you will be asked a few questions about your health and symptoms. Your body temperature may be measured using a thermal gun.
You will find the waiting rooms and elevators empty. Sometimes, you may be asked to wait in your car, until the doctor is free to see you. You may be asked to make payments online, and also submit your previous records beforehand. This is to minimize your time in the hospital, thus decreasing the risk of exposure.
Seeing your doctor in the Covid 19 era
You will be asked to wear a mask, and also gloves. In fact, you will be asked to carry nothing to the clinic, except perhaps your phone.
You may also notice an acrylic sheet separating you from your doctor on the slit lamp. Your chair may be covered in plastic, it will definitely be wiped down before you sit in it.
Everyone in the clinic will be wearing masks and gloves, some will also be wearing giant face shields which will make them look like astronauts. The familiar smiles will not be absent, remember, they will only be hidden behind masks.
Some of the familiar staff may not be there at all. They could be in quarantine, or rotation (most clinics are staggering working hours), some could have been laid off. Remember, the hospitals and doctors are facing the same problems as everyone else.
Eye pressure check
There are some doctors who will continue to want to use the Non Contact tonometer. Some will use the touch tonotometer, called the Goldmann Applanation tonometer. They will all be meticulously cleaned between patients. Your doctor will choose what she thinks is best, as guidelines are continuously evolving about glaucoma equipment.
Gonioscopy
Some doctors will defer gonioscopy, some will rely on AS-OCT which is a non contact method of assessing the angle of the eye. Some will use disposable gonioscopes. These are also clinical decisions yet to find universal resonance.
Visual fields
For most glaucoma patients, visual fields will be deferred. For those with progressive disease, or for glaucoma suspects, your doctor may advise visual fields. You will be asked to wear a mask during the test.
For most patients, doctors will rely more on OCT. For both, the diagnosis and follow up, doctors will rely more on RNFL OCT, which assesses the thickness of the nerve fibre layer around the optic nerve, since it is faster, and easier to disinfect.
Glaucoma Medication in the Covid 19 era
Your may need to stock up on your medication, especially during lockdowns, even though pharmacies continue to remain operational. If your screen time increases during work from home days, your eyes may become dry. You may want to start using lubricating eye drops, or use them more frequently to avoid dryness.
Your doctor will also want you to be very prompt in reporting a red eye. Covid 19 has also presented as conjunctivitis.
Glaucoma Surgery in the Covid 19 era
Unless it is an emergency, your doctor will defer your eye surgery. Also, pre-surgical testing will likely include some form of active COVID-19 or serologic testing. Your doctor may also discuss, and consider, less invasive surgeries, or SLT. This is to minimize the risk of post operative complications, and the number of visits to the hospital
