Author: Richard Gale (United Kingdom)
Co-authors: Jean-François Korobelnik, Anat Loewenstein, Paolo Lanzetta, David T. Wong, Jane Barratt, on behalf of the Vision Academy
Purpose
As cases of COVID-19 continue to fluctuate in “waves” across regions, ophthalmologists must adapt quickly to the changing epidemic pressure to ensure that patients with retinal disease are receiving appropriate treatment while minimizing the risk of COVID-19 transmission. Clear and efficient communication with patients, many of whom will be concerned about how the pandemic affects their access to sight-saving treatment, is more important than ever. This is particularly true for patients with speaking and hearing challenges who may not receive the individualized care they require at a time when healthcare systems are overwhelmed. Here, we discuss simple guidance that can be implemented during the pandemic to ensure optimal treatment, safety, and patient communication.
Setting/Venue
The Vision Academy comprises over 90 international retinal experts who collaborate to provide collective recommendations on clinical challenges in areas where there is a lack of conclusive evidence. The 14-member Vision Academy Steering Committee met in March 2020 to review existing guidance developed for general eyecare visits during the pandemic by ophthalmological societies including the American Academy of Ophthalmology, the French Society of Ophthalmology, the German Ophthalmological Society, and the Royal College of Ophthalmologists.
Methods
The Vision Academy was the first expert group to develop a set of recommendations specifically addressing the need for guidance regarding the management of patients with retinal diseases receiving intravitreal injections of anti-vascular endothelial growth factor (VEGF). As the pandemic progressed with significant local and regional variation in new COVID-19 cases, the guidance was reviewed by the Academy’s membership during its Annual Meeting in August 2020, and updated and graded according to three levels of epidemic pressure. In addition, guidance was developed on how to support patients with hearing and/or speaking challenges during the pandemic. Guidance was voted on by the Vision Academy Steering Committee for consensus.
Results
Management of patients with retinal disease should continue at as close to normal levels as possible during low epidemic pressure and include physical distancing and use of regulation face masks. During high and extreme epidemic pressure, simplification of intravitreal anti-VEGF treatment regimens is recommended to reduce the need for frequent monitoring and dose adjustment. In these situations, those with neovascular age-related macular degeneration (particularly those with ≤2 years of treatment), new patients with significant vision loss, neovascular glaucoma, and monocular/quasi-monocular patients (only one eye >20/40) should be prioritized. Safety measures to limit the spread of COVID-19 can be detrimental to communicating with patients, particularly those with hearing and/or speaking challenges. Face masks disguise facial expressions and prevent lip reading which aids understanding. Masks also alter the audibility of speech, making it more difficult to understand, while physical distancing further reduces the attenuated speech signal, making the conversation even more challenging. Simple steps to improve communication include choosing a quiet, well-lit location with good lighting to aid eye contact and facing the patient directly when speaking. Slow, clear speech with regular pauses, use of written information, hand gestures/body language, and rephrasing rather than repeating the same words can also enhance understanding.
Conlusions
Management of patients during the COVID-19 pandemic should be adapted according to the local epidemic pressure, with prioritization of treatment for those at greatest risk of irreversible vision loss when infection rates are high. Adjustment of anti-VEGF treatment regimens may be required to minimize the risk of patient exposure to COVID-19, but special care must be taken to ensure that patients continue to receive appropriate treatment to avoid long-term vision loss. Clear communication is essential to reassure patients during this challenging time, and small adjustments to how to approach patient conversations can enhance understanding and help ensure the delivery of best possible care.
Financial Disclosure
The Vision Academy is supported by Bayer. Writing and editorial assistance was provided by Hollie Robinson, PhD and Rebecca Fletcher, (BA) Hons, of Complete HealthVizion, Ltd., McCann Health Medical Communications, funded by Bayer Consumer Care AG, Pharmaceuticals, Basel, Switzerland. RG is a consultant for Alimera/Allergan, Bayer, Novartis, and Roche. JFK is a consultant for Allergan, Bayer, Kanghong, Novartis, Roche, Thea, and Zeiss. AL is a consultant for Allergan, Bayer, Kanghong, Novartis, Roche, ForSight Labs, and Notal Vision. PL is a consultant for Allergan, Bayer, CenterVue, Novartis, and Roche. DTW received grants/research support from Bayer, Novartis, and Roche, consulting fees from Alcon, Allergan, Bausch Health, Bayer, Novartis, Topcon, Zeiss, and has minor equity in Arctic DX. The International Federation on Ageing receives consultancy fees from Bayer Global and Bayer Canada with respect to eye health, from Sanofi, Pfizer, GSK, and Seqirus with respect to vaccines, and from Sonova and Cochlear for hearing health.
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