Effect of COVID-19 on Glaucoma

Additional Info

• Audio File:uab/ua184.mp3
• Doctors:Knox, Hogan
• Featured Speaker:Hogan Knox, MD
• CME Series:Quality and Outcomes
• Post Test URL:https://cmecourses.som.uab.edu/mod/quiz/view.php?id=4514
• Guest Bio:Specialties include Cataract and Refractive Disease, Comprehensive Ophthalmology and 
  Glaucoma. 
  
  Learn more about Hogan Knox, MD 
  
  Release Date: February 1, 2021
  Expiration Date: February 1, 2024
  
  Disclosure Information:
  
  Planners:
  Ronan O’Beirne, EdD, MBA
  Director, UAB Continuing Medical Education
  
  Katelyn Hiden
  Physician Marketing Manager, UAB Health System
  
  The planners no relevant financial relationships with ineligible companies to disclose.
• Transcription:Melanie Cole (Host):  Welcome to UAB Med Cast. I'm Melanie Cole and I invite you to listen as we examine the effect COVID-19 has had on glaucoma patients and its impact on patient care. Joining me is Dr. Hogan Knox. He's an Ophthalmologist and Clinical Instructor at UAB Medicine. Dr. Knox, it's a pleasure to have you join us today and what a great topic this is. We've heard about how people have avoided hospitals for things like heart attack and stroke due to the fears of COVID. Have you noticed a sharp drop in care during the pandemic? Have you seen collateral damage specifically, in ophthalmology? Has that been hit particularly hard? Tell us what you've seen for your patients.
  
  Hogan Knox, MD (Guest): Thanks for having me on. So I mean, the pandemic has been going on for such a long time, I feel like there's kind of been multiple stages in how we've cared for patients and what I've seen. But certainly in the first several months a lot of patients that weren't coming in for their appointments. And I mean, talking about collateral damage, I seen numbers of patients you know, three to four months after the pandemic started, that didn't come in when they were having a problem, because they were scared to come in. And then by the time that they did come in, their issue was irreversible and they lost vision permanently because of it.
  
  So, I have a bunch of those stories to tell, but more recently I feel like as a clinic, as a whole, we've become better at making people feel comfortable about coming in. And I haven't seen as much of that recently, but certainly saw a lot of that two to three months ago.
  
  Host: Well then Dr. Knox, how do you make the decision or measure the cost of seeing patients in clinic at their regularly scheduled appointments or a special appointment if their glaucoma is severe versus Telehealth or something if the risk of the patient's glaucoma is progressing to the point of irreversible vision loss? Can you share a status update with us on how you determine whether they do need to come in for that visit or whether it's something that can be done through a Telehealth?
  
  Dr. Knox: Yeah, where we've used Telehealth since the pandemic has started as really just to try to check pressure in a more remote location, you know, one of the big exam things that we do when we check glaucoma patients and we do get visual fields, which, unfortunately requires them to come to the clinic. We get a sort of imaging modality of the eye. And then we also do pressure checks. You know, everybody kind of associates glaucoma with pressure, and it's more complicated than that, but it's an important piece of the treatment. And so if somebody's pressure of the eye is well controlled and it's consistently been well controlled, and their testing has not progressed, over the past several years then that's a low risk patient to have problems even during the pandemic. So, those are people that I would feel more comfortable about saying, you know, it's okay if you space your appointment out another couple of months, thinking the pandemic may come to an end, but, unfortunately for a lot of these patients, glaucoma is a blinding disease and we don't have the means in a Telehealth model to make sure that those patients aren't going to get worse.
  
  And so, we did do some, at Callahan, we had some drive-through pressure checks. It was almost like a screening tool to see if patients needed to be seen or not. And that's good for some people who have already checked into the clinics and already had testing, but it wouldn't be adequate for a new patient exam. So, there's a lot of stuff. We have a lot of Telehealth research going on and stuff, but it's still not quite up to the standards to, to make sure that these people are going to be stable through the pandemic and just able to stay home.
  
  Host: Are they considered high risk for COVID complications? Are they in the high risk category?
  
  Dr. Knox: Well, that's more complicated than that. So, glaucoma doesn't make them in a high risk category, but the fact that they're predominantly an older population. So yeah, you could say yes from that standpoint.
  
  Host: What about the emotional impact the pandemic has had on so many of us, but particularly those with blinding diseases? What have you seen as far as the mental health of your patients?
  
  Dr. Knox: I would say fortunately, just from my routine patients that are coming in for more routine glaucoma care, I haven't seen other than being isolated from their family. It's nothing that the glaucoma specifically has created extra issues for them. People that I've seen, the biggest kind of emotional struggles are the people who are kicking themselves because they didn't come in because they didn't feel safe to come in earlier on during the pandemic. And then again, by the time, glaucoma is a blinding disease. And so if you don't catch it early and treat it early, you can permanently lose vision from it. And so, those are the people that, in my opinion, have had the biggest stresses and just the work, the hardest time with the, with COVID. But I've also seen coworkers, I've had family members and loved ones pass away from COVID.
  
  It's definitely taken a toll on our healthcare system and ophthalmologists, we don't take care of COVID positive patients in the ICU at least currently, but it's just affected so many people now. It's, hard not to see a patient in clinic and not have some sort of conversation about COVID because we're all wearing masks. We're distancing. I'm not shaking hands. Not that we didn't wipe down equipment before, but we're like pretty OCD about wiping down everything and it's a lot different than it was before the pandemic, for sure.
  
  Host: So, do you see in the future any change to care and research for glaucoma as a result of COVID or do you think things will go back to the way that they were? What are some of the things that you changed during this pandemic that you think will kind of stick, will stay with us after it's gone.
  
  Dr. Knox: I think there's a big need for Telehealth. I mean, I know you've kind of harped on it at the beginning and as much as we can keep people home and feel certain that they're not going to be losing vision, then we will do that. It's just the main means that we have to see to check people out of the office is really with different some sort of instrument that we can check pressure.
  
  But I think, yeah, you know, a lot of the resources going on through Callahan with Telehealth has to do with trying to put those imaging software and the visual field software in more rural locations to where patients can go just down the street to get that testing. And then that testing can then be sent to a glaucoma specialist that in a metropolitan area, such as Birmingham or something like that.
  
  So, that's something I think for sure in the future is going to be impactful for glaucoma. It's just not quite there right now. The things that I'll take after this pandemic to change my practices, it’s, mainly I guess sanitation like washing your hands as diligently as you possibly can. And it definitely makes you long for just some of the social interaction that we had and the comfort that you had in just shaking somebody's hand before this pandemic started. Does that make sense?
  
  Host: It does. And as we wrap up, what would you like other providers to know about glaucoma and the impact on patient care that you've seen at UAB as a result of the COVID-19 pandemic? Do you have any advice for other ophthalmologists that are dealing with this as you are from the experts at UAB?
  
  Dr. Knox: You know I mean, everybody's trying to prevent people from going to see a physician. You know, you want to try to stay home as much as you possibly can. But I would just want to emphasize that, I think healthcare in general is a pretty controlled environment to be in, from a sanitation and spread standpoint specifically, in our clinics and hospitals. If anybody's having symptoms, they don't come to clinic. Everybody wears masks. All the chairs are distanced, everything's wiped down before you come in. You're just in the room with a physician. So, it's a pretty controlled environment. Unlike, you know, people that may still be going to restaurants and things like that. And so, I would just hope that we can try to make people feel safe to come in and get their eyes checked if they're truly having a problem. There are a lot of people that I see in clinic that fortunately don't have any issues and I feel comfortable telling those people that unless you're having an emergent issue, you can stay home until the pandemic's over.
  
  But for those people that are truly having issues or their vision's changed, or their eyes hurting, or something's worrisome, those people, I would just want to make sure that they should feel comfortable coming in, just because of the patients that I have seen that have not come in because they felt like they wouldn't be comfortable. And then they've lost so much because of it.
  
  Host: Certainly good information, Dr. Knox, thank you so much for joining us today. A community physician can refer a patient to UAB Medicine by calling the Mist line at one 800-UAB-MIST. That concludes this episode of UAB Med Cast. For more information on resources available at UAB Medicine, please visit our website at UABmedicine.org/physician. And please remember to subscribe, rate and review this podcast and all the other UAB Medicine podcasts. I'm Melanie Cole.
  
  
• Hosts:Melanie Cole, MS