Ian Morris, ophthalmic partner at Specsavers Wick, discusses teleophthalmology and lockdown learnings from practising in Scotland during the pandemic.
‘From the outset, we were set up as an Emergency Eyecare Treatment Centre (EETC) for NHS Highland as Wick and the surrounding area is in a unique position of being both remote and populated.
When the EETCs were introduced, we were approached by the ophthalmology department to help. We had a teleophthalmology system set up allowing us to live-stream our patient assessments to an ophthalmologist if there was something we weren’t sure about or needed help on. The closest dedicated ophthalmology department is 100 miles away, which is at least a four-hour round trip by car and even longer by bus or train.
We have also provided help to secondary care by managing the patients that hospitals weren’t able to see due to the restrictions in place. This has included reviewing patients following retinal detachment surgery and trabeculoplasty surgery. We have also completed intraocular pressure reviews and a review of a 97-year-old with herpetic stromal keratitis and corneal thinning. Our team has performed cycloplegic refractions for kids with significantly reduced vision at screening just before lockdown was introduced.
During the pandemic, I have seen and learned a lot. I feel that the work is more fulfilling as it seems like we are making more of a difference than ever. I have been making video calls using a secure system and patients have sent photos in advance of any potential appointments. We have been able to deal with about half the cases remotely without seeing the patient face-to-face. I have given them advice and prescribed treatments remotely with follow-ups to make sure that treatment is helping.
During the pandemic, I have seen and learned a lot… We have been able to deal with about half the cases remotely without seeing the patient face-to-face. I have given them advice and prescribed treatments remotely with follow-ups to make sure that treatment is helping.
There has been a variety of conditions that I have had to deal with, from more routine conditions like marginal keratitis, uveitis, episcleritis, branch retinal vein occlusions and lots of foreign body removals from DIY gone wrong, to some potentially sight and life-saving treatments. These included a few suspected giant cell arteritis episodes, a patient with a suspect temporal lobe lesion or stroke, a patient with amaurosis fugax with visible embolism, a few optic neuritis cases and one optic papillitis. One patient who sticks is in memory was an 80-year-old patient with a stroke who I referred directly to accident and emergency, where she had a complete hemianopia. I also had to start a first-time treatment of an anterior uveitis patient who was pregnant, which was a new experience.
We provided key workers with replacement glasses or repairs remotely, along with other repairs to patient spectacles. We made appointments to manage the flow and getting patients to drop off the glasses and wait outside or in the car, repairing them and phoning so they can pick them up. This managed the flow into store as we were operating with the door closed in a one-in, one-out system for any patients we needed to see. Anyone we have done a repair or emergency dispense for has been very appreciative.
In Scotland, we were only able to see patients through the EETC where there was a risk to a patient’s sight or well-being if we did not see them. This is probably the hardest part of the crisis. It is normally relatively simple to know what an emergency is, but it is harder to decide what is essential. We still have people phoning and wanting to book an appointment for a routine sight test, so there is demand, but we have to be very strict in who we see to minimise the risk to the patient and staff. Once the restrictions are explained, the majority are understanding.
‘At the outset, I was worried that the practice may have to close as we were told not to see people by the NHS so everything ground to a halt. The announcement of the average payment grant by the NHS and furlough scheme changed everything instantly.
I furloughed nine staff and have been worked throughout lockdown with one assistant. I wanted to keep as many people off as possible as we have a few staff who are shielding. I think with the NHS grant, the majority of practices in Scotland will be able to reopen slowly and I’m sure all optometry practices are grateful for the support.’
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