Eyeworld

102 | EYEWORLD | MARCH 2021 G UCOMA About the physicians Brian Francis, MD Doheny Eye Institute UCLA Geffen School of Medicine Los Angeles, California Sarwat Salim, MD, FACS Professor of Ophthalmology Director, Glaucoma Service New England Eye Center of Tufts University School of Medicine Boston, Massachusetts Inder Paul Singh, MD The Eye Centers of Racine and Kenosha Racine, Wisconsin Kateki Vinod, MD Assistant Professor of Ophthalmology Icahn School of Medicine at Mount Sinai New York Eye and Ear Infirmary of Mount Sinai (NYEE) New York, New York move around the staff, and this change has helped decrease wait time," she said. COVID testing preop is recommended for patients who need surgery with general anes- thesia, Dr. Salim said. Enhanced infection control measures ad- opted at NYEE in spring 2020 are still in place today, Dr. Vinod said. "Patients visiting NYEE undergo a screening questionnaire regarding symptoms of COVID, exposure to infected or symptomatic individuals, and recent travel to 'hot spots."' Outpatients are allowed one compan- ion, if required for assistance with mobility or language translation. After having tem- peratures checked with non-contact, infrared thermometers, patients clean their hands with alcohol-based hand sanitizer and are provided surgical masks upon entry to the hospital. A sec- ond screening questionnaire is conducted once patients reach the ophthalmologist's office. All staff undergo the same process upon arrival to work. Limited numbers of people are allowed in elevators and waiting rooms to allow for social distancing. Dr. Vinod said clinic flow was adjusted to streamline patient visits and minimize time spent in the waiting room between technician workup and the ophthalmologist's evaluation. Slit lamps have breath shields, and all high- touch surfaces and diagnostic equipment are thoroughly disinfected between patients using EPA-registered disinfectants. With patients required to wear surgical masks for the duration of their visit, paper tape is used to seal the top edge of the mask to pre- vent fogging of the lens and minimize artifacts during perimetry, Dr. Vinod said. "We've been using disposable gonioprisms and Goldmann applanation tonometer tips," Dr. Vinod said. "Our non-glaucoma colleagues prefer the iCare and Tono-Pen tonometers [Reichert Technol- ogies] to check IOP, which employ single-use probes and tip covers, respectively. We're also using disposable lenses for our laser proce- dures." She added that all patients scheduled for ambulatory surgery at NYEE are required to undergo COVID testing within 5 days of their surgical procedure. Visitors are not permitted within the preoperative or postoperative areas. Companions are asked to wait in designated areas with seating arranged to allow for 6-foot In Dr. Singh's practice, the waiting room was reorganized for social distancing; technol- ogy is being used as a paging system; and pa- tients can check in online or at a kiosk outside and they're notified when the physician is ready. Dr. Singh said patients like waiting in their car until their appointment time. "I've heard pa- tients say they don't mind waiting a little longer in their car where they can sit back and listen to the radio," he said. MDbackline is a tool Dr. Singh has been us- ing to reduce patient time in the office. Patients fill out questionnaires in advance, giving the doctor and technicians information (personality traits, motivation, and other history) without the technician needing to gather it face to face. "I have that information to make decisions or tailor my discussion with the patient before they come in," Dr. Singh said. Other technologies helping to minimize in-office time for the patient in Dr. Singh's practice include VERACITY Surgical (Carl Zeiss Meditec), which allows the doctor and staff to use patient history, biometry, and diagnostic testing. Dr. Singh described FORUM software (Carl Zeiss Meditec) as a "way to manage all the diagnostic information acquired and consolidate it into one system, but [it] also allows AI to take over." Finally, Dr. Singh said technologies such as the SL 800 slit lamp (Carl Zeiss Meditec), which has a telemedicine component, allows for remote access. If a technician or optometrist is performing a patient workup, the physician can view what's happening from outside the office. At Dr. Salim's practice, patients and visi- tors are screened for COVID symptoms before coming in and again upon arrival. "We have a screening station at the entrance of the building where everyone is asked to clean hands with a hand sanitizer and is provided a mask." Visitors and guests are limited, and Dr. Salim said some administrative staff continues to work remotely to reduce in-house volume. Like many practices, Dr. Salim's clinic has installed Plexiglass at re- ception desks, removed magazines, rearranged waiting room furniture, instituted frequent disinfection protocols, and added signage that reminds of social distancing. "We moved service-specific testing equip- ment to their respective clinics to limit pa- tient movement between floors. We have also changed our workflow so that staff is moving around the patient versus having the patient continued from page 100

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