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Patients who are receiving treatment for Glaucoma require follow up and constant supervision.
For the majority of patients this entails a check-up of the intraocular pressure once every three months, a dilated Retina evaluation every six months and a visual field analysis every year.
The ongoing pandemic has compelled glaucoma specialists to make several changes in the follow-up schedule of the patients
During the lockdown, the majority of our glaucoma patients sought online consultation wherein they were advised on their medications and were counselled regarding any queries they might have had.
Any patient with redness, eye pain and reduced vision was called to the clinic for an urgent consultation. Availability of anti-glaucoma drops was an issue and they were advised on alternative medications if required. When the lockdown measures were relaxed, patients were then given appointments at the clinic.
All standard COVID-19 safety protocols were followed by the glaucoma patients on visiting the clinic. Appointments for patients were staggered so that social distancing measures were maintained. Intraocular pressure was checked using the Applanation Tonometer after cleaning with an alcohol swab. There was a screen fitted on the slit lamp between the patient and the doctor. Dilated exam was deferred unless necessary and undilated examination using a 90D or 78D lens was preferred to reduce the time spent in the clinic.
We started the use of the Humphrey Field Analyser for visual fields after drafting out the necessary protocols. We restricted the appointments to 2-3 a day. Cleaning of the whole apparatus before and after the test was followed. The room was well ventilated and the patient wore a mask throughout the procedure.
The fact that a majority of our glaucoma patients are senior citizens, means there is a certain amount of hesitancy on their part to come for their routine check up. Our staff counsel the patients over the phone before they fix an appointment and the patient is reassured about the COVID safety protocols in place.
We have also looked into the possibility of using some newer devices in the future wherein the patient could check the intraocular pressure at home. This however is still in the trial phase and will have to be standardised before use.
It has been a challenge for every medical practitioner to manage patients in this ongoing pandemic and we have had to put a lot of new protocols in place. Looking ahead we must continue these practices which have been put in place.
Image on top: Mask, PPE, and Slitlamp examination in Pandemic by Niranjan Gaire
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