Retina Specialists in US Hot Zones Report on How Offices, ORs Have Changed During COVID-19 Spread

New Retina Radio, Retina Today’s podcast, featured a conversation with three doctors from hotspots in the United States. John W. Kitchens, MD, moderated a conversation with George Williams, MD, from the Oakland University School of Medicine, outside of Detroit; Gwen Cousins, MD, from Retina Associates New Orleans; and Lisa Olmos de Koo, MD, MBA, from the University of Washington in Seattle.

Selection of intravitreal injection agents was a big topic of discussion. Dr. Williams discussed how his practice is choosing to move patients from bevacizumab to other agents.

For those patients, “we’ll try to switch them over to a longer-acting drug such as Eylea, with the idea that they won’t need to come back as frequently,” Dr. Williams said.

Regarding drug access, Dr. Williams said that his office has “been fortunate so far that even in patients where we can’t get approval [for an on-label drug], we’ve been able to use samples.”

He said that the AAO has been instrumental in collaborating with industry partners to alleviate financial stressors associated with COVID-19.

“[The AAO has] requested and received help on accounts payable,” he said. “Regeneron is now starting with purchases after March 1st. They’ve gone to 150 days payable. That’ll be very helpful. Genentech has gone to 120 days.”

“Kudos to both of those companies for stepping up and doing the right thing,” he added.

Extensions on payment terms is important when you consider the disruption to patient volume.

“We’re about 25% of our volume [compared with] just 3 weeks ago,” Dr. Cousins said. “We sent home any staff that wasn’t essential for patient care.” That included billers and supervisors, who are working from home, she said.

Dr. Cousins forecasted that conditions would get worse before they get better in New Orleans.

“Unfortunately, I think in 2 weeks it won’t have turned the corner just yet,” she said. “As far as ophthalmology practices, it’s probably going to be very similar. At this point, we’re only seeing the most urgent patients that require treatment.”

She reported that the reduced volume in patients has led to a major disruption in the health care marketplace.

“There’re several practices in the area that have just stopped practicing,” Dr. Cousins said. “Both multi-specialty practices and some retina-only practices have basically furloughed their employees and aren’t seeing patients.” She added that patients from those practices have called her office for appointments.

Dr. Olmos de Koo said that her practice was collaborating with the virology lab in at the University of Washington.

“Just today, we’ve implemented routine preoperative testing for COVID-19,” Dr. Olmos de Koo said. “I have three cases booked tomorrow, all retinal detachments. Today all of them got nasal swabbed and we will expect the results tomorrow before those patients have surgery.”

The OR at Dr. Olmos de Koo’s practice has tried to reduce the risk of coronavirus spread.

“We are avoiding general anesthesia whenever possible to reduce a chance for droplet contamination,” she said. “If general anesthesia is necessary, such as if they are a child or have severe claustrophobia, we’re planning on intubating and paralyzing with deep extubation and any measures such as local anesthetic to reduce the cough reflex, draping fully down to the feet to direct the airflow down toward the feet and towards the ground, and trying to stay out of the room at the times of excavation.”

The full New Retina Radio webcast can be viewed below.