With many European states preparing to ease lockdown measures in response to flattening rates of new coronavirus infections, gleaning a glimpse of what the UK’s optical sector may look like following the relaxing of our own business shutdown is increasingly possible.
The University of Manchester’s head of optometry, Philip Morgan, hosted a Facebook webinar last week entitled ‘European Optometry: Life After Lockdown’ that pulled together a number of key opinion leaders from across Europe. During the discussion optometrists from Norway, Denmark, Scotland, England, Germany, Spain and Italy all took turns to answer a range of questions about their country’s current situation and the future, providing a look at the variety of measures being used to ensure safe practice environments as patients return to optical practices.
Lockdown status
European responses to the coronavirus pandemic have been varied, with some countries seeing more success in keeping the new infections rate to manageable levels. The severity of the coronavirus pandemic in each state has informed the severity of the response, with optical practices in some places still closed at the time of writing. Most countries in Europe have allowed optical practices to remain open for emergency appointments, although the definition of emergency has varied.
Spanish practitioner Elena Garcia Rubio, a specialist in paediatric optometry and contact lenses for the control of myopia, decided to close her practice on March 13, two days before the Spanish government locked down optometry excepting emergency services. ‘The Spanish government closed schools in the first week of March and lots of people saw this as opportunity to bring their children to the optometrists. When I walked into my practice on the 13th I saw so many people that I decided to close down because I didn’t believe that we could all be safe,’ she explained.
‘Only 8% of Spanish optometrists have opened and can only conduct face-to-face appointments for emergency care.’ Emergency care in Spain has included replacing broken glasses and providing contact lenses, among a few other choice situations.
Italy’s situation has been similar, as professor of clinical contact lens application at the University of Salento, Giancarlo Montani explained: ‘Around 30% of practitioners remain open here, but there is a very low service for patients. We stay open for only two hours per day while other practices stay closed, opening only for emergencies. Spectacle sales are down by 85% because now people only buy them when they need them and not for fashion.’
In Denmark practices have been open for weeks now, as Bo Lauenborg explained: ‘People were not rushing in when we opened and, compared to a normal working day, we are operating at about 60% of our capacity.’ Lauenborg also highlighted that strict measures are in place to keep infected people away from the practice, something organised ‘effectively’ by the Danish professional organisations.
New practice procedures
The effects of coronavirus on practice life are sure to be profound but what that will look like in the long term remains a mystery. For the immediate future though, countries like Denmark, Norway and Germany provide useful examples.
Norwegian practitioner Erik Robertstad described a range of procedures his practice has adopted since Norway has exited lockdown on April 20. While Norwegian practices were closed except for emergency appointments professional associations in the Scandinavian country utilised the time to work on new protocols to ensure practitioners and patients remained safe.
Before patients come to appointments they are asked via text whether they have any symptoms of infection and are told not attend if they do. ‘When patients come in they have to sterilise their hands at the door and then we ask the same questions about whether they have symptoms. If they’re okay they’re allowed into the practice as before [the pandemic].’ Additionally, Robertstad has worked on his test sequence to group all close-up elements of an eye-test together so he can wear a mask and gloves for as little time as possible. ‘It’s not compulsory to wear a mask, but I do,’ he explained
Robertstad also addressed a question about how to deal with customers trying on frames, explaining that each frame is now either disinfected or kept in a box for 72 hours after being tried on.
Rubio’s practice in Madrid started seeing patients again on May 6, albeit with a skeleton staff. The full range of usual services will be resumed, although the practice’s three optometrists will work in rotation so there is not more than one in the building at a time alongside one receptionist. She explained: ‘We have been working on new protocols because we now have to change the way we work.’
PPE
Personal protective equipment (PPE), its availability and its necessity have all made national news alongside the ongoing pandemic and represent particular areas of interest for front line medical practitioners like optometrists.
German optometrist Heiko Pult commented that while German practices have reopened all patients and practitioners are required to wear masks while in the practice. Looking further into the future, Pult conducted a survey on what sorts of PPE German eye care practitioners would consider using, or asking the patient to use, after lockdown. The results of his survey are presented in figure 1 showing that masks and hand disinfection are the most popular methods for protecting against infection.
Figure 1
Lauerborg is avoiding using gloves in his Danish practice unless absolutely necessary and instead asks patients to handle their own lenses. ‘Sometimes we have patients who can’t handle their own lenses and then it’s just a case of practicing good hand hygiene, as you would normally,’ he commented.
Scottish practitioner Ian Cameron explained that Scottish requirements for PPE have been entirely directed by the NHS: ‘We’re hand-in-glove with the NHS and that really dictates how we’ll practice and use PPE. I’m in possession of better PPE than the NHS recommends but we’re being told what to wear.’
In Spain the government has recommended practitioners wear medical masks but has not made them compulsory. Rubio explained that they were hard to buy: ‘We’re having a hard time trying to buy them but have bought some devices to disinfect the practice and have bought plastic shield masks. I work with children which is more challenging because while they seem to understand wearing a mask they still tend to touch everything.’
Looking forward
The effect of the coronavirus on how optometry is practiced will be profound, with some elements of this slowly starting to be revealed. Cameron commented: ‘We’ve suddenly completely changed what we considered to be safe practice without anything going massively wrong as of yet – usually when someone phoned us seeing flashes and floaters we’d tell them to come in straight away, but now we tell them to wait a few days. The GOC might have to rethink what it recommends.’
The webinar’s host, Morgan, agreed, describing the pandemic as a ‘kind of experiment that examines what happens when we stop seeing patients.’
Nicholas Rumney, the UK-based president of the European Academy of Optometry and Optics, said: ‘It may well be the situation that we take the decision to postpone six month aftercare with contact lenses because we’re balancing the risks; if the risk of coronavirus infection is high and the risk to the eye is low then that would be sensible.’
