Health Policy Institute - HPI

Doctors of optometry essential care guidelines for COVID-19 pandemic

Essential visits may include medical visits related to systemic and ocular disease or injury where there is significant risk of permanent vision loss because of any postponement of care, as determined by the treating doctor of optometry. Studies show that the same groups burdened by COVID-19 complications also suffer more vision problems. This includes those groups of individuals with hypertension (19.6% of this cohort), respiratory conditions (4.4% of this cohort), and heart disease (3.6% of this cohort) and the elderly.i

Essential visits may also include visits where patients complain about discomfort and other symptoms that significantly interfere or significantly hamper day-to-day function, as assessed through virtual prescreening by the doctor of optometry caring for the individual patient. Added considerations could include patients who have lost or broke their glasses or contact lenses; however, this added consideration should only be made by the treating doctor of optometry on an individual basis with consideration given to prescription needs and level of disability without correction.

Table 1.0: Examples of essential care requiring emergency office visit   

Referral of patient from emergency department HPI analysis of 2016 Healthcare Cost and Utilization Project (HCUP) data showed that 1% of all U.S. visits to emergency departments were for eye-related encounters and that 98.9% of those eye-related encounters were treat and release that could be taken care of by doctors of optometry in their offices.
Trauma reported by patient Blunt force, sharp object or foreign body or chemical to an eye; followed by pain, photophobia, sustained flashes of light, metamorphopsia or visual field loss.
Eye pain report by patient Unexplained eye pain that cannot be resolved by virtual methods. This would include, but is not limited to, acute angle closure glaucoma and corneal compromise (e.g. includes pain associated with contact lens wear and not resolvable after discontinuing contact lens wear).
Vision loss report by patient Acute or gradual with or without pain, sudden onset blurred vision, color desaturation. Acute retinal arterial ischemia, including vascular transient monocular vision loss (TMVL) and branch (BRAO) and central retinal arterial occlusions (CRAO), are ocular and systemic emergencies requiring immediate diagnosis and treatment.ii
Double vision reported by patient New onset.
Dropping of eyelid as reported by patient Acute or sudden.
Flashes or floaters reported by patient with or without pain New onset.

i Zheng D.D et. al. Patterns of Chronic Conditions and Their Association With Visual Impairment and Health Care Use. JAMA Ophthalmol. 2020 Feb 27
ii Biousse V; Management of Acute Retinal Ischemia: Follow the Guidelines! Ophthalmology. 2018 Oct;125(10):1597-1607