Optometry and COVID-19: the view from Europe

As well as outlining how the COVID-19 pandemic has affected daily practice, European optometry: Life after Lockdown provided a chance for optometrists from different European nations to turn to how the profession will evolve in the future. 

Below OT shares a whistle-stop tour of some of the points covered on the night.

Norway

Speaking from his consulting room in Norway, Erik Robertstad, explained that optometry practices closed for clinical services for many weeks during lockdown.

“We had one day where all optometrists in Norway were completely closed. The day after, authorities realised that people did need to go in to get their spectacles and so on. We were allowed to open but only for emergencies,” he said.

From Monday 20 April, optometry practices were able to reopen in Norway.

“The professional bodies were working intensively on routines and what kind of protection we would use. I think one of the most important things is to avoid getting people into the practice with symptoms,” Mr Robertstad said.

He added that his practice is asking patients whether they have symptoms by text before they attend in person. They are asked to call the practice if they are unsure whether to attend a physical appointment.

“When patients arrive at the practice and go through the front door they have to sterilise their hands and then we ask them the same questions – have they lost their sense of taste or smell? Do they have shortness of breath or a cough? There are specific questions to ask,” Mr Robertstad shared.

Here in Scotland it is feeling like we are heading into an ice age where optometry will operate in an unusual way for a long time

If a patient passes this screening process, they are permitted to progress to an eye examination, contact lens fit or other clinical appointment.

However, Mr Robertstad highlighted that there are safety measures in place. The premises is cleaned more often and staff are diligent about cleaning equipment and surfaces between patients.

“It is not compulsory to wear a mask, unlike many other European countries but I personally wear a mask. My patient will sit far away from me while I go through history and symptoms. When I do more close up work I will put on my mask and gloves,” he said.

Germany

German optometrist Dr Heiko Pult explained that optical practices opened in his area again last week.

He shared that in Germany everyone must wear face masks while taking public transport and in shops, although face masks are not required when someone is walking on the street.

“At the moment we are working eight hours a day wearing face masks, even if the patient is seven or eight metres away,” Dr Pult explained.

He added that face masks pose challenges because they can cause glasses, trial frames and instruments to become foggy.

Denmark

While optometry practices have been open in Denmark for the past two weeks, Danish optometrist Bo Lauenborg shared that demand has not immediately picked back up.

“People are not running into the store…We normally run five clinics and today we had three clinics so we are running at about 60%,” he said.

Cataract operations started again last week. There are now few restrictions on optical practices, with optometrists permitted to advertise for new customers.

However, Mr Lauenborg highlighted that customers cannot make online appointment bookings with practice staff calling patients instead or receiving calls from patients.

This provides an opportunity to ask questions about the health of patients who request an in-person appointment.

Spain

Optometrist Elena Garcia Rubio highlighted that schools closed in the first week of March in Spain.

Optical practices were very busy during this time, Ms Rubio added.

“On March 13, when I walked into my practice there were so many people that I wasn’t sure if it was safe. In that moment, I decided to close the practice,” she said.

Optical practices in Spain are only permitted to offer face-to-face appointments for emergency care. Of the 10,000 optical practices in the country, less than 8% are open, Ms Rubio shared.

Broadband is now at the apex of our hierarchy of needs…If this had happened 25 years ago, goodness knows what would have happened

From Monday, optometry practices will be able to open by appointment and from 11 May all stores except for malls will be able to open in Spain.

“We have been working on protocols to go back to practice because we have to change the way we work,” Ms Rubio said.

Italy

Italian optometrist Giancarlo Montani shared that optical practices in Italy are permitted to open for two hours each day and are also available to open as needed for emergencies.

He shared that he has seen an 85% reduction in spectacle sales and a 45% reduction in contact lens sales.

“With our lockdown it is still difficult to move. We have to use a self-certification for everything. If I want to buy food, I have to write a self-certification to go to the shop,” Mr Montani said.

Scotland

Scottish optometrist Ian Cameron shared that all face-to-face care is being offered within designated emergency eyecare treatment centres (EETC) within Scotland.

All optometrists triage patients over the phone and then refer them to these centres if needed.

Within Edinburgh, where Mr Cameron is based, the EETC is located within a hospital.

It is staffed by independent prescribing optometrists, has the required personal protective equipment and staff receive appropriate training.

“In rural settings they designated certain practices that you could refer to,” Mr Cameron shared.

He shared that while Scotland is ahead of other UK nations in releasing information about what a lockdown exit strategy might look like, the detail is still reasonably vague.

“I heard somebody describing this crisis as three horizons; as a blizzard, a winter and an ice age. If it’s a blizzard you hunker down and you get through it. You don’t make any changes. If it’s winter, you might put on an extra jacket. For an ice age, you sell all your summer clothes and you prepare for an ongoing life in a new way,” Mr Cameron observed.

“Here in Scotland it is feeling like we are heading into an ice age where optometry will operate in an unusual way for a long time,” he added.

England

English optometrist Nicholas Rumney shared that his local hospital in Herefordshire shared a resilience plan with the practice after the COVID-19 emergency unfolded.

Staff also made prescribing pads available to optometrists within the practice.

“Their instruction to us was ‘We are looking to you to stop people coming through the door of accident and emergency’,” Mr Rumney noted.

The practice has furloughed 14 staff, with seven staff remaining to provide a skeleton service of urgent and essential care.

Mr Rumney estimated that turnover is around 11-12% of what it would normally be.

By offering a telephone triage service, patients who urgently need care are still able to receive treatment. Cases triaged by Mr Rumney’s practice include microbial keratitis, retinal tears and herpes simplex keratitis.

The COVID-19 pandemic has caused optometrists to value digital technology more, Mr Rumney highlighted.

“Broadband is now at the apex of our hierarchy of needs…If this had happened 25 years ago, goodness knows what would have happened,” he emphasised.