Doctors rebound from COVID-19 limitations, settle into ‘new normal’

Despite fewer or relaxed public health restrictions, doctors of optometry still face innumerable challenges that govern practicing at pre-COVID-19 levels with many settling into a "new normal."

Recently published by the AOA Health Policy Institute (HPI), the Second Nationwide Impact and Response Survey of Optometry Practices During the COVID-19 Pandemic finds most optometry practices nationwide—92%—reopened for the full range of comprehensive eye health and vision care services in June, yet patient volume still lingers around 50-75% of pre-pandemic levels. Nonetheless, this is good news for patients and doctors alike considering only 8% of doctors reported patient volumes of more than 25% of their pre-pandemic volumes in April.

While the survey indicates optometry's gradual rebound from the height of COVID-19 restrictions in March and April, when doctors of optometry were suddenly limited to essential and emergency eye care, this new normal comes with significant changes in patient care and practice decisions.

"It is gratifying to see optometry practices rebound and patients being cared for—clearly the demand for care is out there and our colleagues are working hard to meet that demand," says Steven A. Loomis, O.D., AOA HPI chair. "At the same time, it also is clear that providing a 'COVID-safe' environment is expensive and time-consuming for doctors of optometry and staff because of a necessary reduction in patient flow to meet social distancing guidelines, as well as the need for PPE.

"Doctors of optometry will likely have to reevaluate their business models to ensure that those costs are offset. High-volume, low-margin models won't be sustainable in the post-COVID world."

In March, the Centers for Disease Control and Prevention (CDC) issued guidance that instructed health care providers nationwide to postpone elective visits as SARS-CoV-2, the virus causing COVID-19, spread unabated in U.S. communities and triggered states' lockdown or stay-home orders.

Later reversed in April, the guidance suddenly limited optometry practices to urgent, emergent care only for several weeks. At the time, the AOA HPI's first pandemic survey found that 80% of optometry practices provided urgent and emergent eye care so patients did not need to crowd emergency departments providing COVID-19 care. In fact, doctors of optometry helped divert over 206,000 patients away from emergency departments during March's surging caseloads, freeing up much-needed resources and reducing infection risk.

Despite optometry's ability to provide urgent, emergent care only, the profession faced difficult sacrifices. Significantly, three-fourths of doctors personally took a reduction in income to protect their practice.

Patients seeking regular appointments, care

While the AOA HPI's second pandemic survey of 833 doctors of optometry across all 50 states suggests a more favorable situation for optometry practices in June, only a quarter of doctors report current patient volume is more than 75% of pre-pandemic patient volume—and one in five doctors report 50% volume or less. What's more, 55% of doctors continue to provide essential optometric care (surgical or non-surgical) as of June; however, only 25% report providing only emergent or urgent care.

While certain optometric services haven't recovered as immediately—three-fourths of doctors who typically provide vision therapy or rehabilitation services are not currently providing that care—others, such as contact lenses, are rebounding with 83% of doctors currently performing fittings. However, contact lenses bring their own concerns, manifesting in June's survey results:

• 89% of doctors reported verification calls for invalid prescriptions.
• 54% of doctors were called for the wrong prescription.
• 43% of doctors received calls for someone who was not a patient.
• 17% of doctors reported "other" inaccuracies or errors, such as expired prescriptions, substitutions or previous authorization given. Still, the lifting of pandemic restrictions nationwide has led to more patient visits with
• 71% of doctors reporting a patient waitlist for scheduling appointments. This resurgence in patient appointments is welcome news, permitting nearly half of doctors to recall furloughed or laid-off employees.

COVID-19 infection, PPE concerns still prevalent

However, concerns about COVID-19 infection and community spread still weigh heavily on the minds of optometry practices and their patients. Nearly two-thirds of reporting doctors say they or their staff have concerns about safely returning to the office and nearly one in five furloughed or laid-off staff indicated they cannot or will not return to the office.

Likewise, nearly two-thirds of doctors say their patients are communicating concerns about office visits for appointments and, therefore, a third of doctors are continuing telehealth use to decrease or eliminate time in the office.

Such infection concerns are not unwarranted—the AOA HPI survey found one in five doctors having treated a COVID-19-positive patient since April and, moreover, almost one in 10 doctors saying they themselves or their staff have been diagnosed or tested positive for the virus. Both represent increases from April, when only 3% of doctors reported having treated a COVID-19 patient and only 2% indicated they or staff have tested positive.

To allay that infection risk, doctors of optometry and staff are encouraged to wear appropriate personal protective equipment (PPE) when performing close-proximity patient care, as well as adhere to rigorous infection control protocols. Whereas PPE availability was a concern in April—55% of doctors initially reported an inadequate supply—less than a third of doctors now report that problem.

Additionally, current care recommendations call for the maintenance of a 30-day supply of personal protective equipment (PPE) and optometry practices currently seem optimistic in meeting that goal:

• 85% can maintain a 30-day supply of gloves.
• 82% can maintain a 30-day supply of office cleaning/sanitizing supplies.
• 74% can maintain a 30-day supply of goggles, safety glasses or face shields.
• 60% can maintain a 30-day supply of N95 or KN95 masks. However, half of responding doctors indicate they have concerns about the authenticity of the PPE materials they are using, especially in light of concerns about counterfeit PPE.

AOA's advocacy, resources benefit professions

Given the evolving nature of this pandemic and the U.S. public health response, the AOA remains committed to providing the most up-to-date information and resources, as well as continuing its all-out mobilization and 24/7 advocacy on behalf of the profession and patients.

As noted in AOA's HPI survey, vast majorities of doctors and optometry practices have found the most benefit from the AOA's re-opening resources, including the #AskAOA webinar series, and benefited from AOA's advocacy into Medicare/Medicaid provider relief payments and other CARES Act provisions.

Access the AOA HPI's Second Nationwide Impact and Response Survey of Optometry Practices During the COVID-19 Pandemic for greater detail and insight into these findings.