Quarantine and glaucoma do not go together well. To track glaucoma, we have to see patients every few months and measure their IOP. Visits are usually scheduled two or three times a year, but we might see someone with unstable glaucoma as frequently as every 2 weeks. But when the coronavirus hit New York City and someone in our office tested positive, we immediately shut down and saw no patients for a full month. I haven’t been able to see patients as I normally would, but I’m proud to say that by taking a proactive approach to treatment, I’ve given them an added level of safety during this time. By managing glaucoma with SLT, their IOP is controlled without visits and, in many cases, without medication.
I certainly did not anticipate that a global pandemic would keep my glaucoma patients away. But on a large scale, it’s entirely predictable that unexpected events like illness, family emergencies or job loss will impair or stop a patient’s compliance with glaucoma management. For example, it’s common to see patients cruising along with well-controlled glaucoma until they break their hip. The rehab facility doesn’t have their glaucoma meds, their pressure gets out of control, and they go blind.
With this in mind, rather than putting patients on medication and waiting for glaucoma to get worse before I step up treatment, my approach is very proactive and assertive from the start. To get pressure as low as we can, my first-line treatment is SLT (Lumenis Selecta Duet), plus medication if needed. I tell patients SLT is their “insurance policy” – if they forget to use their medication (and they will), SLT can prevent them from losing their vision.
I see the benefits of this approach every day in my patients’ IOP control and quality of life, but when coronavirus sent us all into quarantine and glaucoma visits stopped, I knew this approach was also helping preserve vision for my patients isolating at home. We’d chosen to get ahead of the problem, so they could afford to sit it out for a while. Doctors who decided to sit out the first round of glaucoma treatment, opting for medication and a wait-and-see approach, were headed for difficulty as COVID-19 forced them to sit out the second round. Patients without laser may be at much higher risk during quarantine, just as they would be during any other life event that disrupts medication use and office visits.
As restrictions have lifted allowing us to see glaucoma patients again, some patients without SLT have chosen not to come in, even after we explained the risk to their eyesight. Most of these folks are over 80 years old, and they all know people who’ve been diagnosed with COVID-19, so I cannot fault their caution. Nevertheless, a handful of patients who opted not to have SLT will be missing that added layer of security against blindness provided by the laser.
As more patients return to the practice over the next year, we will renew our focus on treating them in a way that minimizes visits. Laser is a critical element of that plan. It’s a particularly ideal modality for this situation because appropriate candidates decide in the office, have in-office treatment, and don’t need to return until their regular glaucoma check-up months later. When they see us less often, they can safely stay at home, and we can more easily carry out the new protocols for patient distancing in the office. I’m very proud of reducing patients’ risk of vision loss during the coronavirus pandemic, and when the world eventually moves on, I hope more of us will realize that glaucoma patients always need an insurance policy for whatever life has in store.