On the ground

Coronavirus: on the ground in Youghal

County Cork optometrist Sue Doherty on teaching a nurse to fix her child’s spectacles using a hairdryer, and cars as the new waiting rooms

Ireland and UK map

As the coronavirus (COVID-19) pandemic transforms the way optometrists practise, OT is sharing the experiences of optometrists across the UK and beyond. If you, or a colleague, is interested in sharing your story please get in touch by email. 

I practise on the south coast of Ireland in County Cork, in a seaside town called Youghal. It has a population of around 6000 people, which is an average sized town here. We have a small independent optometry practice, which I opened in 2007.

We closed our doors on 28 March when Ireland imposed restrictions and have triaged queries over the phone since then, providing emergency care where required. Before restrictions eased on 18 May, I would see around five patients face-to-face each week. I also work with a private ophthalmologist one day a week in a post-cataract clinic, but I am not working there anymore because all elective surgeries have been cancelled. Many private hospitals are now under management of the Health Service Executive (HSE), which has temporarily ceased all private work.

During lockdown, I dealt with emergency spectacle breakages, patients with emergency symptoms like foreign bodies or sudden loss of vision and triaging patients for eye casualty. Here, we do not have the structured pathways for referral that there are in the UK. I call eye casualty and check if I can send the patient in. They won’t see any patients without phone triage; the patient is given a designated time and date to attend. In some areas in Ireland, all referrals still have to go through the GP. It can be challenging at the best of times and COVID-19 has added to that.

Ireland has some of the longest public waiting lists for eye care in Europe. Some patients can be waiting anything from a year to three years for a cataract referral. I would hope that new opportunities will arise from COVID-19 to create better links with tertiary care. Perhaps the powers that be will recognise the value of involving our profession more.

I think optometry here would be very willing and eager to play a role in reducing waiting lists. I certainly am. We do have a two-tier health system here with a private and public pathway.

Sue Doherty
Irish independent optometrist Sue Doherty

Unlike the UK, optometry practices with HSE contracts in Ireland have not received any average monthly payment or subsidy. HSE payments would be the equivalent of General Ophthalmic Services payments. We are very much out on our own. Practices are making use of the layoff government wage subsidy, which more than 400,000 people have applied for.

We had no allocation of PPE from the HSE. In the early days of closure, most of my working day was spent trying to find a supply of PPE for myself so that I could offer emergency care. I tried here, there and everywhere to buy masks, hand gel, aprons and gloves. It has been challenging, but fortunately our Association of Optometrists has been able to source masks and visors for us and provide them at cost. This was welcome as many suppliers were charging grossly inflated prices.

I think there was a real eagerness in the community for us to open again. That kept us all going

 

It is a tricky time financially. We are reliant on the goodwill of landlords and the goodwill of suppliers. The government offered some support to SMEs in the form of rate rebates and low-cost loans. I have been very lucky with my landlord, who approached me and said ‘Don’t pay any rent for three months.’ There are plenty of others who are not in the same situation. Many are running on empty.

We had our first wave of easing restrictions from 18 May. Opticians were designated as one of the first businesses that could reopen, which was a welcome development. My aim when I return to routine appointments will be to work more efficiently. I am a chatter so I will have to tone down on the chit chat with patients or get that out of the way on the phone first.

I read in a newspaper here that your car is the new waiting room. I think that could be true for a lot of us. My practice has a digital phoropter so we should be able to refract the majority of patients while maintaining social distancing. OCT will help us reduce touch time with the patient for retinal health examination. I plan to offer a dilated fundus exam with OCT to all patients. The main thing is that we continue to provide the level of service that we have become known for.

The information from government to the country as a whole has been good. From the point of view of direct advice to optometry, it has been poor. We have had no guidance from the HSE. It has been a collective effort among individual practitioners and the profession as a whole to come together in WhatsApp groups, Facebook groups and Zoom calls to figure out how we are going to get through this and how we are going to restart our practices. It has been very much self-led.

Up until Monday 5 May, we were allowed to exercise within two kilometres of our home. Since then, that has been extended to five kilometres. Our over 70s are now allowed out to exercise rather than cocooning all the time. Before that point they weren’t even leaving the house for short walks. That is going to be nice for them. There are lots of stories in the media of drive-by waves to grandparents in the window. We are all looking forward to seeing our families again.

In Ireland, we were stopped by the police service during the lockdown. They were very active in ensuring that people weren’t going beyond the permitted zone or making unnecessary journeys. Every day that I went to work, I would get stopped at least once, if not twice, on a journey of 45 kilometres. I was asked if my journey was essential and I had to show a letter that I wrote saying that I was travelling to work.

Our government did take it seriously from day one and they did act very quickly. The numbers are reducing. Our phase five lockdown exit is due at the end of August. We are hoping life will be somewhat back to normal and most businesses will be open again.

Within my practice, I have a large paediatric patient base. There have been lots of phone calls where a parent says, ‘The dog ate the glasses,’ ‘my child was jumping on the trampoline and they broke their glasses’ or ‘his brother pulled the glasses off and smashed them.’ We have managed to sort them all and the customers have all been very grateful. Being able to offer emergency care during lockdown was rewarding and worthwhile.

I have also found ways of doing things that I never considered before. I have looked at various lid bumps and red eyes through FaceTime. I have taught a nurse who was self-isolating with possible COVID-19 symptoms how to put her son’s lenses into the frame using a hair dryer. I am making the most out of what we have.

Before lockdown eased, I had three or four regular patients who would phone for a weekly update and we would have a chat. I think there was a real eagerness in the community for us to open again. That kept us all going. Patients still need us, and of course we will be delighted to see them now that practices are open again.

 

• As told to Selina Powell.