The speed and extent of the recovery of services will depend on the epidemiological situation and patients’ discipline.
That is the opinion of Prof Marko Hawlina MD, Professor of Ophthalmology at the University Eye Hospital of Ljubljana, Slovenia.
He noted that in Slovenia there is a four-tier system of admissions: urgent (up to 24 hours), very fast (up to 14 days), fast (up to three months) and regular (up to six months).
“During the epidemic, only urgent and very fast admissions were considered after a phone consultation that ascertained the need for admission and to exclude eventual symptoms of COVID-19. Others have been rescheduled. In recent weeks, as the epidemic has come under control, fast and regular admissions are also considered,” he said.
Measures put in place to protect ophthalmologists include obligatory masks for the patients, reduced frequency of appointments to reduce congestion in waiting rooms and increased air flow in the rooms, said Prof Hawlina.
“If the patient has symptoms or confirmed COVID-19, they are seen in a specially dedicated examining room with full protective equipment. If patients require surgery such as retinal detachment or severe trauma, they are tested and COVID-positive patients are transferred to a dedicated OR with full protection measures in place. If negative, they would be operated in the regular way, respecting preventive measures for asymptomatic patients,” he said.
During the lockdown, all ophthalmologists in Slovenia have been instructed to take care of their patients by offering advice over the telephone and to inform them about the postponement of scheduled visits, said Prof Hawlina.
“If there was a serious reason to see the patient, he or she would be advised to come for a check-up, respecting all the preventive measures in place. On several occasions, patients sent the images that they made with their smartphones or made a short video. That certainly helped us in assessing the severity of the case. There were a number of red-eye complaints that turned out to be mild, but there were also severe cases of keratitis and trauma that needed immediate attention. Telemedicine may have its role in connections between ophthalmologists at secondary and tertiary level, but not between the patient and ophthalmologist where smartphones do the job well,” he said.
Dealing with the backlog of patients as the lockdown measures are relaxed will mean a very busy summer ahead for ophthalmologists, concedes Prof Hawlina.
“Previous waiting lists will be rescheduled according to severity of the condition. Obviously, all the patients that have conditions that can irreversibly damage the eye will have priority. We will also be expanding our clinic hours to speed up the throughput of patients. At university hospitals, 12-hour shifts will be put in place. This is especially important to accommodate the backlog of patients that missed their scheduled anti-VEGF treatments or others that might have been at risk of irreversible damage,” he said.
As Prof Hawlina sees it, the COVID-19 pandemic represents a valuable learning experience for all medical professionals in general, and young ophthalmologists in particular.
“As older colleagues have been advised to work from home, young ophthalmologists are in the front lines having more opportunities to independently manage the patients in emergency care, and gain new experience in surgery. Although regular operations such as cataracts or oculoplastic surgery, with the exception of tumours, were postponed during the pandemic, senior colleagues are always at hand for telephone/picture consultations and can come to see the patient if needed,” he said.
Professor Vladimir Pfeifer MD, an ophthalmologist at the University Eye Hospital, Ljubljana, Slovenia, believes that the current crisis will inevitably result in a profound and enduring transformation of the way his practice is run.
“The organisation is complex,” he said. “The patients will enter the practice through the main door, they will be given a surgical mask, water-resistant gown, a cap and gloves. The patients will leave the practice through the back door. The patient flow will be in one directly only. From the first recovery room, patients will enter the operating room, the surgery will be performed and patients will leave the operating theatre through another door to the second recovery area, where they will receive eyedrops, medication and documentation, and then leave after a few minutes.”
The idea is that patients will never interact or meet with another patient, explained Professor Pfeifer.
“We will no longer check them on the day of the surgery anymore. The day after surgery they will receive a phone call. Only one patient is going to be in any of the rooms at any one time, and after he or she leaves, the equipment will be fully disinfected. The staff will all wear FFP2 masks, gowns, nitrile gloves, caps and eye protection. They will disinfect their hands after each patient. The surgeon will have a PPF3 mask but no special eye protection,” he said.
A week prior to surgery every patient will be interviewed by phone and given detailed instructions for the procedures to be followed on the day of their operation. The need for punctuality and close adherence to the guidelines will be impressed on them. The patient will also receive by post a questionnaire about COVID-19 symptoms and a statement of honour declaring that they are symptom free. The patient has to sign both documents and upon arrival to surgery a week later the nurse will go through the questionnaire with the patient again and ask if there are new symptoms. The nurse also has to sign the document.
After the lockdown restrictions have been eased, priority will be given to the elective surgeries that were postponed because of the pandemic. Professor Pfeifer explained.
“Later on, we will start seeing new patients. To cope with backlog of patients the practice will remain open longer, and the surgeries will be performed in the morning and in the afternoon by two different teams, each working for six hours a day. The members of the two different teams will not meet to ensure optimal safety,” he said.
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