In the wake of COVID-19, state governments all passed similar acts requiring "non-essential" businesses to close their doors. Optometrist offices that offer both essential and non-essential care were asked to avoid routine visits, and only provide services they deemed essential. The response from optometrists wildly polarized into one of two groups. Which group you choose to be in may determine whether you come out of the quarantine bankrupt, or booming with business.
The Shut Down Response
Corporate opticals led by example in immediately shutting down all of their dispensaries on March 20, 2019. Unfortunately, many optometrists saw this trend and decided to also completely shut down. They felt that most of their services as optometric physicians were non essential, specifically citing "routine vision" services such as providing glasses or contacts prescriptions, addressing blurry vision or dry or itchy eyes, and IOP checks. Most practices locked their doors and left voicemail greetings announcing that they were closed except for emergencies, followed by a tone and deafening silence.
The reality is that a patient who feels they have a true eye emergency will not leave a message or anxiously wait for a call-back from a business that is closed. They will keep searching for someone to address their emergency until they get confirmation that they will be seen and treated. The patient does not care whether their first responder is an optometrist, an urgent care, or an emergency room. In the patient's mind, their emergency is an emergency. In the end, many have been driven to hospital settings to address eye pain and eye injuries. This undermines the entire purpose of the quarantine, part of which was to keep hospital beds available for COVID-19 victims.
The Show Up Response
The polar opposite response by some optometrists has been to step up as essential health care workers in this epidemic crisis. We recognize that our constant availability is essential at this time to treat the following types of emergencies and essential services:
- Broken or lost glasses: When a patient has a high prescription and their glasses are gone, they may be functionally blind. This may disable them from doing an essential job, or even simply going about their daily lives as usual. Without glasses, a patient with a life-threatening disease like congestive heart failure may no longer be able to read the instructions for their medications. Restoring their vision is an emergency.
- Ran out of contacts: Same rationale. Without an optometrist, they may lose the ability to read news updates and government recommendations on how to stay safe. If unable to drive due to their vision, quick access to other essential services is severely restricted.
- Frame is too loose or crooked: The higher the prescription, the more this becomes essential to address. Glasses are a medical device regulated by the FDA. A loose frame could fall off during a critical time such as when doing a blind spot head check while driving on a freeway. A crooked frame can induce vertical double-vision while driving. Addressing these issues is an emergency for these patients.
- Blurry Vision: If the vision in either eye is blurry, it could be due to papilledema, wet macular degeneration, a dislodged intraocular lens, corneal haze from acute glaucoma, or diabetic myopic shift from a life-threatening blood sugar level. For all of these emergencies, sometimes the only symptom is blurry vision.
- IOP Check: If a patient was scheduled for a pressure check, perhaps their IOP is usually good. But there is a reason we monitor it. If their eye pressure goes up to 38 mmHg, the patient will likely have no symptoms, and they will slowly go blind until you finally perform your IOP check. IOP checks are not routine. Preventing imminent blindness is essential.
- Dry or Itchy Eyes: Some diabetic patients have neurotrophic keratopathy. They can have large corneal ulcers that to them only feel like mild to moderate dry eye. These ulcers carry a very real threat of permanent blindness if the cornea gets infected or vascularizes. Herpetic keratitis is also notorious for presenting with little or no pain in the beginning, yet can rapidly cause permanent blindness.
Organizations support essential optometry
One insurer, EyeMed, recognized that it is essential to provide their members with open, practicing doctors. EyeMed assembled a team to call all of their optometrist providers and determine which offices were reliably open, versus which offices were basically closed. When patients called EyeMed looking for available providers for their vision emergencies, EyeMed was able to immediately direct them to open offices. (Because I remained open, EyeMed referred dozens of patients to me from all over my metroplex, and the patients were glad to drive any distance to see someone who was open.)
The US Military recognized that it cannot shut down. The vision of military personnel is essential to national security. The Military Entrance Processing Station (MEPS) continued throughout COVID-19 to process new recruits, including essential vision testing which they outsource to optometrists. (Because I remained open, my local MEPS began to send me every single recruit they needed tested, which is often about 5 patients each day for complete medical exams and special testing.)
Nursing homes and assisted living facilities have gone on total lockdown, denying all visitors including family. The only people allowed in are essential health care workers, like primary care physicians, home health aides, and optometrists. (Because I remained open, I was able to provide essential care to many facilities in my area, including on site and telehealth, which is billable through medical insurance.)
Many patients established at other offices encountered vision emergencies during the COVID-19 shut down. (Because their offices were non-responsive and I remained open, all of those patients have left their non-essential unavailable practices and established themselves at my practice.)
Long-term effects on your practice and career
Many practices who chose to shut down may find it challenging to get patient flow up to sustainable levels again, because many of their patients feel they have been abandoned when they were most in need. Over the next few months as they open and see more patients, their cost of goods and labor will jump back up, but it will not be supported by any insurance payments for the previous months during which they were closed. The worst is not over for these practices, and some may not survive.
Practices who chose to stay open have been thriving. Open practices get a steady influx of new patients with vision emergencies. Practices who continue to see patients with symptoms of possible emergencies like blurry vision or dry itchy eyes are generating sustaining income, creating patient loyalty, and sending a message to the public that their services are absolutely essential. No medical exam or procedure a doctor of optometry does is routine or non-essential. There are too many preventable diseases that can painlessly blind our patients, and we are the only ones positioned to intervene and save them. As a courtesy, we may bill our essential medical services to a vision insurance as a "routine" exam, but that billing courtesy does not make us non-essential health care providers.
Pandemics are not new, even if the scope of our current situation, and our response to it, is unusual. Recall the 2017-2018 US seasonal flu with a death toll of 80,000, the 2015-2016 Zika virus, the 2009-2010 H1N1 Swine Flu, the 2002-2004 SARS outbreak, the 1980s HIV/AIDS pandemic, the 1970s Smallpox pandemic, the 1960s Cholera pandemic and H3N2 Hong Kong flu, the 1950s Polio outbreak and H2N2 Asian flu, the 1918-1920 H1N1 Spanish flu, the 1916 Polio outbreak . . . we skipped over a lot of them here. Many reoccur chronically. What has changed now is the worldwide government response to pandemics. With the speed of information today, the government has set a new precedent to shut down all non-essential businesses during future pandemics.
What does this mean for new optometrists?
You must decide as doctors what your response will be when pandemics hit. Are you going to shut down, or are you going to step up and care for your patients? If you want to thrive through the coming storms, align yourself now with practices that allow you to provide patient care during shutdowns. Communicate to your patients your important role in their lives, and train them to not to neglect their eye care. When pandemics come and businesses around you are closing their doors, email, call, and text your patients that you are open, and that their vision is essential. Don't be distracted or devalued by corporate politics. It is up to you as a doctor and optometric physician to rise up, provide your patients with essential care, and thrive through the storm.
