Optometry diverted 206,000+ during COVID-19’s March surge

Doctors of optometry provided urgent and emergent eye care for over 206,000 patients at the height of March's pandemic lockdowns, diverting vulnerable populations away from emergency departments coping with surging coronavirus caseloads.

Published in July by the AOA Health Policy Institute (HPI), a new report details optometry's significant patient care contribution during a tenuous period for America's COVID-19 pandemic response and estimates an additional 26,861 individuals could have been diverted if only optometry's scope of practice laws were consistent with those in the most advanced states. The findings underscore how essential doctors of optometry are to the emergency workforce and coordinated public health response going forward, especially as states and localities prepare for a resurgence of COVID-19 infections.

"It's clear from these results that a very high number of doctors of optometry kept their practices open just to provide emergency services," says Steven A. Loomis, O.D., AOA HPI chair. "Given that optometry practices are geared to primarily provide comprehensive care, the request to provide emergent care only came at a tremendous financial cost to doctors of optometry. But these results revealed that doctors of optometry did exactly that.

"Despite significant financial sacrifice, doctors of optometry all over the nation kept their doors open to provide care for a multitude of emergent needs, including but not limited to corneal foreign bodies, acute conjunctivitis, vitreous detachments, keratitis and iritis, just to name the most common. Without the provision of those services in-office, patients would have no option other than visiting the emergency departments of hospitals already overwhelmed with potential COVID-19 patients."

Officially declared a pandemic in early March, SARS-CoV-2, the virus causing COVID-19, spread alarmingly fast in the United States and triggered a spate of school and office closures, as well as state lockdown or stay-home orders, to "flatten the curve" of hospitalizations. Then, on the same day the nation reported its 100th death from COVID-19-March 17-the Centers for Disease Control and Prevention (CDC) issued guidance that instructed health care providers to postpone elective visits.

Although later reversed in April, the guidance effectively limited optometry practices to urgent and emergent care only. Nonetheless, doctors of optometry nationwide remained available in their communities, as well as expanded their services to provide telehealth consultations, to help alleviate the numbers of non-viral infectious emergency department visits at a precarious time.

In fact, while viral infectious disease-related visits to emergency departments soared by as much as four times, the CDC's National Syndromic Surveillance Program (NSSP) reported overall emergency department visits declined 42%, from 2.1 million to 1.2 million visits per week. Now, new data suggest the primary care provided in optometry clinics helped contribute to that decrease.

Urgent, emergent optometric care

Per the results of the AOA HPI's nationwide optometric practice survey, April 22-May 6, 89% of doctors of optometry reported providing urgent and emergent care during the pandemic, while 60% of patients treated during that time would otherwise have sought care at an emergency department or urgent care center had the optometry practice not been providing essential care.

Using this optometric practice survey data alongside Healthcare Cost and Utilization Project (HCUP) data showing 1% of all U.S. emergency department visits are for eye-related encounters—98.9% of which can be taken care of in optometric practices—the AOA HPI found approximately 85,700 individuals possibly diverted to optometry practices. What's more, based on monthly projections of past HCUP data, an additional 120,927 individuals were likely seen by optometry and not counted by NSSP national surveillance methods, the HPI report notes.

"This being the case, a significant percent of the reduction in observed emergency department visits described by the NSSP data during the early stages of the COVID-19 pandemic may likely have been accommodated outside the emergency department by optometry," the HPI report notes.

All told, the AOA HPI estimates 206,627 individuals were seen by optometry in the one-month measurement period with urgent and emergent care cases further broken down in the report.

The AOA HPI noted that as stay-home orders increased nationwide, Americans resorted to activities that may be to blame for many of these injuries, such as chemical injuries from cleaning or lack of eye protection during household or yard work.

"These injuries are best treated in an eye doctor's office regardless of the pandemic because the optometry office is better equipped with diagnostic instrumentation specific to the eyes not typically found in the emergency department," the HPI report notes.

While most emergency department visits for eye-related encounters can be treated in a primary care optometry setting, it's also more cost effective by allowing the patient to avoid significant hospital usage fees. Previous HPI publications that describe emergency department usage data shows that diversion of eye-related visits to optometry saves more than $9 in $10 dollars, a 78% savings over the savings from the diversion of all other services combined.

Implications for optometry's scope

Significantly, the optometric practice survey also revealed that 13% of doctors of optometry were forced to refer patients elsewhere for care they were otherwise trained, willing and able to provide, yet disallowed by their respective scope laws. Relying on the same analysis, the AOA HPI estimated an additional 26,861 individuals could have been diverted from emergency departments during the NSSP COVID-19 measurement period if only scope laws were consistent with those in the highest state scope of practice.

"While evidence demonstrates optometry's quest to accommodate emergency care and promote diversion from emergency departments during the pandemic and beyond, the AOA HPI unfortunately found evidence that states' outdated scope of practice laws may have prevented doctors of optometry from doing even more during this time," says Michael Duenas, O.D., AOA chief public health officer.

Therefore, the COVID-19 public health emergency highlights the necessity of updating optometry scope of practice laws consistent with National Board Testing, professional training and expertise, to even better respond to the current pandemic, as well as any future emergencies, the AOA HPI report concludes.