Could telehealth help eye care practitioners adapt contact lens services during the COVID-19 pandemic?

Abstract

The COVID-19 pandemic has necessitated government-imposed restrictions on social interactions and travel. For many, the guidance has led to new ways of working, most notably a shift towards working remotely. While eye care practitioners (ECPs) may continue to provide urgent or emergency eye care, in many cases the travel restrictions present a unique challenge by preventing conventional face-to-face examination. Telephone triage provides a useful starting point for establishing at-risk and emergency patients; but patient examination is central to contact lens patient care.The indeterminate period over which conventional practice will be suspended, and the risk that resumption of 'normal' practice could be impeded by a potential secondary peak in COVID-19 cases, hastens the need for practitioners to adapt their delivery of eyecare. Specifically, it is prudent to reflect upon supportive evidence for more comprehensive approaches to teleoptometry in contact lens practice.Smartphone based ocular imaging is an area which has seen considerable growth, particularly for imaging the posterior eye. Smartphone imaging of the anterior eye requires additional specialised instrumentation unlikely to be available to patients at home. Further, there is only limited evidence for self-administered image capture. In general, digital photographs, are useful for detection of gross anterior eye changes, but subtle changes are less discernible.For the assessment of visual acuity, many electronic test charts have been validated for use by practitioners. Research into self-administered visual acuity measures remains limited.The absence of a comprehensive evidence base for teleoptometry limits ECPs, particularly during this pandemic. Knowledge gaps ought to be addressed to facilitate development of optometry specific evidence-based guidance for telecare. In particular, advances in ocular self-imaging could help move this field forwards.

Contact lens wear and care in Spain during the COVID-19 pandemic

“…Unfortunately, respondents of this study showed both behaviours (showering as well as use of tap water during lens case cleaning). Similarly, Vianya-Estopa et al Nagra et al [32] highlight that aftercare appointments had traditionally offered an ideal opportunity to assess contact lens compliance, but in the current times ECPs are encouraged to also use alternative ways (e.g. videos or patient information sheets, raising awareness of lens care phone apps).…”

“…Daily disposables offer an advantage over reusable lenses in terms of non-compliance with cleaning and care procedures (relying on optimal handwashing only) [ [30] , [31] ]. Nagra et al [ 32 ] highlight that aftercare appointments had traditionally offered an ideal opportunity to assess contact lens compliance, but in the current times ECPs are encouraged to also use alternative ways (e.g. videos or patient information sheets, raising awareness of lens care phone apps).…”

Assessment of contact lens wearers’ attitude toward contact lens wear and care during Coronavirus Disease 2019 (COVID-19) pandemic: A cross-sectional online survey

“…However, this enterprise might be new-fangled in Jordan because of the lack of experience and legislation related to telehealth in general and teleoptometry in particular. In the UK, Nagra et al have also pointed to possible limitations of using teleoptometry by ECPs because of difficulties in the development of optometry specific evidence-based guidance for teleoptometry [ 41 ].…”

Soft contact lens wearers’ compliance during the COVID-19 pandemic

“…In agreement with this, the present results indicate that the simplicity of daily disposables offers a significant advantage as opposed to the complex steps required to achieve full compliance with reusable lenses. [18 19] However, swapping a patient to daily disposable lenses of the same stated parameters does not result in the same lens fit [32] and telemedicine is not at a stage where lens fit can be accurately assessed remotely [33], so unless the patient has worn a particular soft daily disposable contact lens before, changing during the pandemic is not a safe option. During these challenging times, practitioners have been asked to exercise their professional judgement when monitoring the care of contact lens wearers [34].…”