Coronavirus: on the ground in Belfast
Ophthalmologist Tunde Peto on receiving COVID-19 training, the impact of the pandemic on diabetic retinopathy screening, and watching birds in her garden to unwind
As the coronavirus (COVID-19) pandemic transforms the way optometrists practise, OT is sharing the experiences of optometrists across the UK. If you, or a colleague, is interested in sharing your story please get in touch by email.Like everywhere else in the UK, we have temporarily paused diabetic retinopathy screening for the vast majority of patients. We are still seeing pregnant women in specific clinics where the consultant is present so if they need treatment, they are treated immediately. We are also seeing urgent referrals from before the COVID-19 period for laser treatment and anti-VEGF injections into the eye as required. We have to be very careful that social distancing is followed. There are very strict clinical criteria as to how and when they can enter the building where we are providing treatment. The current clinical guidance is that you minimise the number of times that someone needs to attend a clinic and you minimise contact.
I think we will see the emergence of innovative pathways. We are finding that patients are happy to talk with us on the phone and those who are internet savvy are happy to use video technology. This is a major shift in everyone’s thinking. A lot of our patients are elderly and they have been apprehensive about virtual clinics in the past. At the moment they are distanced from their loved ones and their grandchildren, so if they have a smartphone they are learning new functionalities just to see their family. They are less apprehensive about going on some of the video conferencing systems because that is what they are doing with their children and grandchildren.
I have worked in a number of countries around the world, and I have never seen anything like the COVID-19 outbreak. I don’t think anyone has
I suspect that when the lockdown eases we will be using some of the online options better and we will not have such a pushback from regulators, the patients and families. People treasure the fact that they didn’t have to come to the hospital. I would hope that people don’t want to go back to the old normal, and that we maintain good relationships with community optometrists and cherish the learning that has taken place during this period. I think people will realise that there are ways of making the lives of patients easier and also creating more fulfilling roles.
Several of my optometrist colleagues are looking at fundus images and grading outcomes at the diabetic eye screening base, which can categorise patients by degree of severity. They are checking that the most at-risk patients have been seen in ophthalmology. There is a balance to be made between whether the risk of visual loss is greater than the risk of the patient coming out of self-isolation.
Many colleagues have been redeployed to the COVID-19 wards. Those of us who remain providing ophthalmology services are very busy. Even with a smaller number of patients and social distancing, the clinics are still very demanding. Patients can arrive quite anxious about the appointment. One of our clinics is just opposite the Mater Hospital, which is one of the COVID-19 centres in Northern Ireland. We had to explicitly state in the letter that the clinic is not in the main Mater Hospital. Immediately, more patients were happy to accept the appointment.
We all have to make sure that we chip in so we can provide optimal, speedy care. We have successfully changed some of the models in casualty so if a patient comes in and needs to be seen by a sub-specialty they go straight to the sub-specialty to reduce the number of contacts.
We are now starting to prepare for re-starting the service and working out how we will prioritise patients. The service will not re-start with a big bang. We are working on the principle that we are probably going to be maintaining social distancing for three to six months minimum depending on how and when the second wave hits and also whether there is an effective vaccine. We will have to think about priority groups who have a high risk of visual loss and move through the list on that basis.
For a long time, there have been plans to move patients who had two consecutive diabetic retinopathy appointments without disease to two-yearly screening. This has been shown to be safe in smaller areas of the UK within trials and is the recommendation within Scandinavia. It is entirely possible that COVID-19 will make that transition absolutely necessary.
You can’t go into work being afraid. I have gone into work with the mindset that this isn’t going to be the best period of my life, but I need to make the best of it
In Belfast, juniors working within ophthalmology have been redeployed to the COVID-19 wards. All of us had basic training on how to identify the disease itself as well as training on the wards just in case we had to be redeployed quickly. Colleagues who have been redeployed had further training and mentoring. However difficult this situation has been, we have all worked together. We discussed what our strengths are and how we might be able to fit in. We want to contribute as much as we can without being a burden. It has been a very positive experience to work with other sub-specialties.
You can’t go into work being afraid. I have gone into work with the mindset that this isn’t going to be the best period of my life, but I need to make the best of it. We are all very vigilant and wary of the processes we need to follow. I try to be absolutely centred on my work. I think that is one of the reasons why this period can be difficult. You constantly have to be focused. Even small tasks, that seem very repetitive, you have to think about.
I have worked in a number of countries around the world, and I have never seen anything like the COVID-19 outbreak. I don’t think anyone has. As a clinician, you think that at some point in your life there will be a disaster that you need to work through. All of your training prepares you for being focused and being able to cope with adverse events. This is prolonged. There will be new social norms. We are all going to have to learn to adapt.
Ophthalmology was the busiest sub-specialty before COVID-19. The patients are there. We all worry about them. We think ‘Ok, at the moment we can only provide care for those who are absolutely urgent’ but there is that second line there. They are not urgent today but will be tomorrow. We wonder about the missing retinal detachments – where are they? Are they just sitting at home and not coming or are people not getting detachments because they are not going to work or going sky diving? I am not sure how it is going to pan out. We will probably not know the full extent of the impact of COVID-19 for another year or two.
• As told to Selina Powell.