Five opportunities in the wake of COVID-19

Inevitably, individuals and sectors will pick themselves up and take their bearings in this new landscape.

During lockdown, there has been a chance for optometrists to reflect on what the profession offers at its essence. What remains when traditional equipment is either discarded or adapted?

Stalwarts of the testing room, from air-puff tonometers to trial frames and even the humble tie, are now viewed with a degree of suspicion because of an enhanced focus on infection control.

Although protocols and equipment may change, optometrists will continue to care for their patients; that remains constant.

These extraordinary times have opened up opportunities within optometry. OT has heard from readers about initiatives being enacted in weeks, that previously would have taken years to implement.

Perhaps the path ahead is not all doom and gloom. As optometrist, Dr Euan McGinty, told OT: “It's useful to remember that after the Spanish flu, the next decade was the roaring twenties.” Below are five opportunities for optometry following the COVID-19 pandemic.  

1. A standardised approach to urgent eye care

The pandemic has fast-tracked a consistent model for the provision of urgent eye care within England.

Before the pandemic, funding for providing urgent care was dependent on whether a Minor Eye Condition Service (MECS) existed within an area – and what was provided within this service also varied locally.

The new COVID-19 Urgent Eye Care Service (CUES) addresses the patchy provision of urgent and emergency eye care within the community and also provides a means for funding remote consultations – a key feature of the ‘new normal’ within optometry.

I don't think we'll be looking backwards following the implementation of CUES. What it delivers to the system is huge

The framework was developed by NHS England, the Local Optical Committee Support Unit (LOCSU) and the Clinical Council for Eye Health Commissioning and is expected to be implemented locally by Clinical Commissioning Groups.

Talking with OT, LOCSU interim clinical director Zoe Richmond said she expected that CUES will be around for at least two years.

“I don't think we'll be looking backwards following the implementation of CUES. What it delivers to the system is huge. It goes far beyond just delivering for the immediate crisis in urgent eye care,” she emphasised.

2. Closer relationships between optometry and ophthalmology

As the pandemic has unfolded, healthcare professions have been working together in new ways.

Many examples have come across the OT newsdesk of optometrists working with colleagues in secondary care to ensure that patients can continue to receive the eye care they need.

Belfast Health and Social Care Trust ophthalmologist, Tunde Peto, explained that after routine diabetic eye screening was suspended in Northern Ireland, optometrist colleagues looked through fundus images and grading outcomes to ensure that the most at-risk patients were still seen.

“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,” she shared.

Following the outbreak, a new resource was created to help patients and optometrists access the most up-to-date information on the opening times and contact details for ophthalmology services and eye accident and emergency clinics in London.

However difficult this situation has been, we have all worked together

An ophthalmology registrar at Moorfields Eye Hospital, Jonathan Than, plotted data contained in the Directory of London Ophthalmology Service Provision into a Google Map.

Mr Than shared with OT: “I appreciate that optometrists often face significant barriers when seeking advice from, or referring a patient to, an eye casualty unit. Such barriers include lack of clear referral pathways, inability to contact on-call ophthalmologists, and confusion as to where and when a patient should be referred. I hope that this map can address some of these issues to break down these barriers and encourage harmonious collaboration between optometrists and eye casualties.”

3. Enhanced use of remote care

Social distancing has meant that optometrists are changing the way they work to limit the amount of patient contact time.

There is a broad spectrum of adaptations that practitioners are making, from taking patient history over the phone to conducting entire patient consultations using video call technology.

Interim guidance from the Royal College of Ophthalmologists on reopening ophthalmology services highlighted that some trusts are considering using virtual and video clinics as a default for most patients in high-volume sub-specialties.

Belfast ophthalmologist, Tunde Peto, told OT that while some elderly patients were apprehensive about online communication before COVID-19, this was the only method that many of them had to talk with their families during lockdown.

“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,” she said.

“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,” Ms Peto added.

Moorfields Eye Hospital clinicians published a paper in Eye outlining how COVID-19 would transform the future of glaucoma care delivery.

We have been given a once in a generation opportunity to discover new ways to deliver glaucoma care

Dr Hari Jayaram, deputy director of glaucoma service and consultant ophthalmic surgeon at Moorfields Eye Hospital, told OT: “With social distancing becoming a necessary norm for the foreseeable future, we have been given a once in a generation opportunity to discover new ways to deliver glaucoma care. These times have shown us the possibilities that telephone clinics can bring to a glaucoma service and we can see them having a place in optometry beyond the pandemic, alongside efficient prioritisation of the most at-risk patients, virtual review of remotely collected data and, less often than before, traditional in-person clinics.”

Colin Pettinger, who co-owns three independent practices in the Northern Highlands of Scotland, told OT that he is considering using remote consultations for some follow-up appointments after the lockdown eases.

“For me, it has been an epiphany,” he shared.

“I think many people will be taking a good hard look at how they practised before COVID-19,” Mr Pettinger said. 

4. More optometrists managing eye conditions within the community

Many eye care services offered within hospitals were suspended during the UK-wide lockdown, including cataract surgery and screening for diabetic eye disease.

As secondary care faces increased pressure, optometrists working in the community may have the opportunity to ease this burden by managing more eye conditions within the community.

Before the COVID-19 pandemic, ophthalmology had the highest level of outpatient appointments of any specialty within the NHS.

The Royal College of Ophthalmologists has encouraged collaboration with optometrists to help manage workloads as lockdown eases.

In its interim guidance on reopening ophthalmology services, the College encourages the use of referral refinement, virtual screening and clinics, as well as providing “as much care as possible” through optometrist shared care pathways.

5. Rethinking the time allocated for each appointment

Infection control and social distancing measures will increase the length of time that needs to be allocated to safely see each patient in practice.

This creates challenges for the traditional funding model that underpins many practices, but there is also an impetus to reassess whether previous ways of working were fit for purpose.

Practices that already offer longer appointment times and derive a higher proportion of income from clinical care may be better placed to adapt to the challenges posed by social distancing.

Other practices may explore whether this is a model that would be viable within their patient base.

Time pressures are commonly cited as a source of stress within the profession. A survey of more than 1700 AOP members in 2017 found that more than half of the optometrists surveyed work to ‘tight’deadlines, with higher daily appointment numbers linked to increased stress levels.