Are Ophthalmology Practices Adhering to AAO Guidelines?

As the coronavirus disease 2019 (COVID-19) pandemic continues to takes its toll on the nation’s medical providers and treatment facilities, many specialists are struggling to balance maintaining routine care while minimizing patients’ exposure to the virus.

Recent reports of asymptomatic patients leaving COVID-19 viral material on surfaces after eye exams, in addition to earlier preliminary findings that the virus could be transmitted through the eyes, have contributed to several barriers to receiving eye care.

However, a new study published in JAMA Ophthalmology found that as of April 30, 2020, most practices were complying with the American Academy of Ophthalmology (AAO) guidelines for scheduling patients during the pandemic.

“Across outpatient medicine, all specialties have considerably altered practice patterns, focusing on acute or emergent care to ensure safety of both patients and health care workers and to preserve medical equipment and supplies,” the researchers wrote. “Ophthalmology, in particular, has seen perhaps the greatest decrease in outpatient visits among all medical specialties.”

To better understand practice patterns for common ocular complaints during the initial stage of the COVID-19 pandemic, the researchers collected data from 40 private practices and 20 university centers across 4 regions of the country.

“We divided the country into 4 regions: Northeast, South, Midwest, and West,” the authors said. “Within each region, we identified 10 comprehensive private practices and 5 university medical centers with comprehensive ophthalmology practices for a total of 60 comprehensive ophthalmology practices.”

The cross-sectional study took place on April 29 and 30, 2020, with the investigators placing telephone calls to each office and recording responses to 3 clinical scenarios: refraction request, cataract evaluation, and symptoms of a posterior virus detachment (floaters, flashes). Ophthalmologic subspecialty practices such as those treating glaucoma, cornea, neuro-ophthalmology, pediatrics, or retina were excluded from the study.

Each investigator had a script to use when addressing the practice while an office was considered closed if there was no answer after 2 attempts during normal business hours or a voice mailbox message indicated closure.

The researchers then compared responses regionally and between private and university centers.

The study yielded the following results:

• Of the 40 private practices, 2 (5%) were closed, 24 (60%) were only seeing urgent patients, and 14 (35%) remained open to all patients
• Of the 20 university centers, 2 (10%) were closed, 17 (85%) were only seeing urgent patients, and 1 (5%) remained open to all patients
• University centers were more likely than private practices to mention preparations to limit the spread of COVID-19 (17 of 20 [85%] vs 14 of 40 [35%]; mean difference, 0.41; 95% CI, 0.26-0.65; P < .001)
• Private practices had a faster next available appointment for cataract evaluations than university centers, with a mean (SD) time to visit of 22.1 (27.0) vs 75.5 (46.1) days (mean difference, 53.4; 95% CI, 23.1-83.7; P < .001)
• Private practices were also more likely than university centers to be available to see patients with flashes and floaters (30 of 40 [75%] vs 8 of 20 [40%]; mean difference, 0.42; 95% CI, 0.22-0.79; P = .01)

When it comes to telemedicine, the researchers found no significant differences between private and university centers when analyzed by region or COVID-19 prevalence. Specifically, “a total of 7 of 40 private practices (18%) offered telemedicine services, while 3 of 15 university centers (20%) were offering telemedicine visits (mean difference [MD], 0.17; 95% CI, 0.10-0.23; P = .81).”

Results suggest comprehensive ophthalmologists appeared to be abiding by guidelines in place at the time, which suggested evaluation only for urgent patients, although more private practices were open to all patients during the pandemic and more university centers were more likely to only see urgent patients.

The Researchers point out that during the time the calls were made, vastly different approaches to public health safety and health care practices among states in different regions were being implemented, potentially influencing responses. However, all states included in the study had stay-at-home guidelines in place.

“Interestingly, areas with higher prevalence of COVID-19 had no difference for any metric for any of the scenarios presented, but practices were more likely to ask about COVID-19 symptoms when scheduling more urgent appointments,” the authors conclude. “This study identifies that most comprehensive ophthalmologists were abiding by guidelines suggesting evaluation for only urgent patients, with minimal differences between private practices and university centers.”

Reference

Starr MR, Israilevich R, Zhitnitsky M, et al. Practice patterns and responsiveness to simulated common ocular complaints among US ophthalmology centers during the COVID-19 pandemic. JAMA Ophthalmol. Published online August 5, 2020. doi:10.1001/jamaophthalmol.2020.3237