May 5, 2020
By Robert Burke
When Sheila Morrison, OD, MS, FSLS, begins treating a child newly diagnosed with myopia, she expects to have some long talks with the patient and the parents. “They have a lot of questions because most are not aware of the eye health risks associated with myopia,” she says.
Even under normal circumstances, it takes time to explain the myopia management options and help families see their way forward. But in this pandemic environment, with practices laying off staff and open fewer hours if they’re open at all, providing that level of intensive counseling is a challenge.
Dr. Morrison is one of four optometrists at Mission Eye Care in Calgary, in Canada’s Alberta province. The practice specializes in myopia care and other eye health conditions. It closed to most patients on March 15 and since then has found ways to provide the needed myopia care, even though it has had to reduce in-person care mostly to emergencies.
Dr. Morrison lives close to the practice location and has the most time flexibility, so she handles all the urgent care needs. Those patients are allowed in on a case-by-case basis. Social distancing and cleaning protocols are in place for everyone. “I’m in the office seeing patients every day,” she says.
Myopia care, though, is not easily delayed or interrupted. “We have had to have doctor consultation time available to discuss personally with parents” what the practice can do to continue treatment, she says. “Ortho-k lenses break. Supplies of Soft multifocal lenses run out. Pharmaceutical prescriptions need refills,” she says. “All of these things are considered essential services to our patients, and we work with them to meet these needs.” In addition, they’ve extended all warranties for in-progress fits for myopia control and specialty lens patients.
The ODs have been offering telehealth consults for about a month. Doxy.me is the service they use. Having a secure platform for video interactions with patients and sharing images is a useful tool, but it has its limits. “Whenever it’s safe to do so I appreciate the advantage we have in diagnosing and managing ocular conditions through the use of a slit lamp and imaging technology,” she says. “Telemedicine cannot replace those tools.”
The practice is now seven weeks into its partial shutdown. It prepared by training staff to triage the urgent-care and emergency patients, and it takes urgent-care referrals from other practices in the area that are fully closed. Dr. Morrison calls that work a “pay it forward approach. Those of us who are providing urgent care are not making any money doing that, but it’s worthwhile and these patients need it.”
The practice did its best to prepare for and adapt to the pandemic-driven changes, she says. But the stress is palpable. She can hear it in the phone calls staff take all day from patients. “We really see it; everybody wears down. Our staff members are constantly a little bit on edge, for a good reason. They’re worried that they’re bringing some exposure home to their families.”
Adjusting to that pressure is part of surviving the pandemic’s effect. “If you don’t have your frontline people healthy and happy, you don’t have anything for your patients,” she says. The ethic she and the staff try to follow with patients is “kindness and understanding. Our office has made a collective decision to do that.”
The tentative plan is to have a slow re-opening, from urgent care only to semi-urgent care, probably around the end of May, she says. They’ll modify the practice space and make it easier to maintain social distancing, and continue the protocols for disinfecting workspaces and making the in-person contact safe for patients and staff.
But the timing of a full reopening is unknown. “We do not expect to have our usual multi-doctor” system back until health officials say it’s safe, and any government restrictions are lifted. It’s going to take several months, Dr. Morrison predicts. “It’s been challenging for the practice,” she says. “At the end of the day, we all have to carry on, and what we are facing is the adaptation of new norms and ways of life.”