Nearly two months after the American Academy of Ophthalmology issued a practice guidance urging ophthalmologists to cease providing “any treatment other than urgent or emergent care,” the group is now taking steps to consider the process of reopening ophthalmology care.
“Our efforts and the efforts of millions of our fellow citizens have succeeded in flattening the curve compared with the prognostications of many of our most thoughtful public health experts. Some parts of our country (most notably places like New York City, New Orleans and Detroit) have suffered horribly,” David W. Parke II, MD, CEO of the AAO, wrote in a letter posted on the Academy’s website. “Other areas, thankfully, have had a considerably more muted experience.”
Parke noted that one observation from this experience is that the impact has been regional, but that Americans are all connected.
“A hot spot in one area can impact other areas if we do not take care to limit transmission,” he wrote.
According to Parke, while the Academy’s recommendation to curtail ophthalmic practice was national in scope, the decisions to return to more normal practice will be made on a local and regional basis.
“They will be based on local and state governments, on public health authorities interpreting local patterns of disease, on testing availability, on institutional policies and ultimately on individual ophthalmologists,” he wrote. “While we closed routine practice nationally, we will open locally.”
Parke stressed that ophthalmology is not “returning to normal.”
“The lessons learned from COVID-19 may mean that the normal of January 2020 may never approximate the normal of the future,” he added. “We will have the SARS-CoV-2 virus with us for years. We will always have the memory of what it means to shelter in place for weeks on end, to furlough staff and to defer patient care. What we must do now is develop the processes to provide patient care in a new normal.”
Peter J. McDonnell, MD, chief medical editor of Ophthalmology Times,® and director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, agreed that decisions will be complex and will depend on several variables from region to region, including the decisions of government officials (in some parts of the country there are executive orders preventing doctors from providing non-urgent care).
“So legally, the governors or, in some cases mayors, would have to decide to allow practices to reopen,” he said.
McDonnell also noted that the degree of community spread varies widely, with some counties in the United States having zero cases and others heavily affected and not yet reaching their peaks.
“For instance, right now in Baltimore we are approximately flat while in neighboring Washington, D.C., the curve is still up and their peak is not projected to occur for some time in the future,” he said.
According to McDonnell, many industry leaders are recommending that should only occur when a region has been on the downslope in terms of number of cases for two weeks.
“So that is obviously a local and not a national data point,” he said.
Moreover, when clinics begin to reopen, precautions will be in place, including the use of protective masks, social distancing, and limiting the use of waiting rooms.
“Some clinics might be better able to reopen sooner because they have better access to personal protective equipment and perhaps a larger physical plant allowing them to avoid having patients next to each other in waiting areas, etc.,” McDonnell said.