Do You Have to Choose Between Your Health and Your Vision?
At AMDF we have been thinking a lot about how many of you in the AMD community may be concerned about being more at-risk from COVID-19 as described by the CDC (Centers for Disease Control) and how both fears and reality may affect your decisions about maintaining your AMD care.
To address concerns regarding macular degeneration care during the COVID-19 outbreak, we consulted with the American Academy of Ophthalmology (AAO), Dr. Johanna M. Seddon, ScM, Professor of Ophthalmology at University of Massachusetts Medical School and Director of the UMass Macular Degeneration Center of Excellence, and Dr. Rahul N. Khurana, Retina Vitreous Associates of Northern California.
What you might expect at the clinic
AMD clinics are taking precautions to insure the health and safety of patients by reducing the potential for virus transmission and enforcing social distancing. Though each office will have their own variations on protocols, the general guidelines they are following are:
- Rescheduling routine patient visits
- Postponing elective surgeries
- Asking patients over the age of 60 without urgent ocular problems to stay home
- Having patients wash their hands immediately upon arrival
- Decreasing the number of patients in the waiting room
- Regularly disinfecting surfaces
- Having staff members wear masks and gloves
- Having doctors and nurses wear ocular and oral shields to prevent virus transmission during close examinations
- Informing patients that the ophthalmologist will speak as little as possible during parts of the examination, and requesting that the patient also refrain from talking in these moments.
Additional precautions being taken at clinics:
- Telling patients with cold, flu, and allergy symptoms to stay at home
- Positioning a sentry at the door to screen entering patients
- Screening patients with questions about fever, cough, travel history, and the travel history of family members
- Asking that patients wear a surgical mask if they have any sign or symptom of respiratory disease
- Rescheduling the visits of those who are sick, have a cough or fever, have been exposed to COVID-19, or have recently traveled outside the United States
- Referring patients and staff members with a temperature above 99.5º to their primary care providers
- Limiting patients to only one visitor accompanying them (other friends or family must wait in the car)
- Asking anyone accompanying a patient to remain outside the building, where they will be contacted by text message when the patient departs
- Positioning chairs in the waiting room 6 feet apart from each other
- Removing magazines and beverage areas from the waiting room
What you can do to maintain your vision health during these difficult times
For patients with early, dry AMD: postpone non-urgent doctor visits, maintain home monitoring and continue making healthy lifestyle choices.
“Patient – physician conversations are the most important element of establishing a patient’s course of action under today’s circumstances,” says Dr. Khurana, “Any change in your vision should be reported to your eye care specialist.”
At home, you can track changes in your vision by using the Amsler Grid (you can find a free downloadable version at our website here https://www.macular.org/amsler-chart ). It is advised to monitor at least once a week.
If your doctor has advised supplements with lutein and zeaxanthin, continue with those, as well as an eye-healthy diet (which is also good for your heart and general health). However, if you are taking a supplement for AMD that contains zinc (which is included in the recommended AREDS and AREDS2 formulas), Dr. Seddon advises that taking additional zinc lozenges for cold or flu prevention may lead to zinc toxicity. Check with your doctor, as your AMD supplement may already supply all the zinc you need to maintain your immune system.
Q: I have dry AMD that has, so far, been relatively stable. I have an upcoming eye appointment to monitor my condition. Should I keep or postpone the appointment?
A: As of 3/19/2020 the AAO is advising ophthalmologists to only see patients with urgent or emergent care needs. From their statement: “Due to the COVID-19 pandemic, the American Academy of Ophthalmology now finds it essential that all ophthalmologists cease providing any treatment other than urgent or emergent care immediately.“
If you qualify as at-risk for COVID-19 complications and you haven’t detected any changes in your vision, check in with your eye care specialist. It is likely your appointment will be postponed.
Q: I have dry AMD and have noticed a sudden change in my vision. I’m also at high risk from complications due to COVID-19. Should I see my eye doctor now?
A: In this case, call your eye doctor to discuss your vision changes over the phone to determine if there is any sort of vision emergency. You and your doctor will have to weigh how urgent it is for you to be seen in office. You may need to be seen by a designated doctor on call for urgent care.
Q: I spoke with my eye doctor and they feel it’s important to be seen in office to determine the cause of my sudden change in vision. I’m still worried that doing so could expose me to COVID-19 and I’m at high-risk. What should I do?
A: Most offices are taking extreme precautions and few people are in one room together, since non-essential appointments are being canceled. If your doctor feels it’s important for you to be seen in office, it’s reasonable for you to ask what precautions they are taking to reduce the risk of COVID-19 exposure and spread. .
“Don’t assume that a clinic is closed due to the coronavirus pandemic,” says Dr. Khurana. “Check with your doctor. Some areas are harder hit by the virus than others, but most offices are still open and trying to see patients in the safest manner. Guidelines for AMD clinics have been established, and each clinic has established their own version of these protocols, so please do not become concerned if circumstances at the clinic differ a little from those you have heard or read about.”
You can also ask if they have a private area to wait in rather than a crowded waiting room, or perhaps that they offer an appointment time when they know there will be low traffic. If you are extremely concerned about maintaining proper social distancing, you might also request that they contact you by cell phone as you wait in your car for your appointment. In this scenario you’d have to let them know that you have arrived and that you are waiting nearby.
Not every office may be able to accommodate special requests.
Q: I have wet AMD and receive monthly eye injections. I’m also in a high-risk group for COVID-19. I feel I’m having to decide between my vision and my health/life. What should I do?
A: This is a tough decision. Studies confirm that maintaining a regular schedule of eye injections is important in retaining the vision you have, and missing even one appointment can have a negative effect.
Remember that clinics are making special accommodations for high risk patients, as described above. Call ahead of your appointment to make sure that these are in place.
According to Dr. Khurana, “Seniors should not sacrifice their sight to fear. Anti-VEGF injections are essential for those who require them, and should not be skipped – even in a shelter-in-place scenario. If you must come in for essential care, take appropriate precautions like handwashing and social distancing, and come in.”
That said, there’s no question that your health and life are most important.
Call your retinal specialist’s office and request a phone appointment to discuss your options. Based on how long you’ve been receiving injections and how stable your vision is, your doctor may be comfortable with stretching the time between injections — but that is a determination that must be made by your doctor.
“The ophthalmic community considers our seniors and everyone in a high-risk group to be a valuable part of our society,” says Khurana. “We want to perform essential care to preserve your sight.”
Q: I’ve spoken with my doctor and feel the office is accommodating high risk patients safely. However, my transportation there feels risky (public transport, or a driver). What should I do?
A: Many people are suddenly working from home and may have more flexibility to give you a ride. If you have a friend, neighbor or family member who can drive you, and who you trust has been extra careful with their own exposure, this would be a better option than any type of public transport, ride-share, or public service transportation.
Ask that they wear a mask, and don’t be embarrassed or shy in asking about their exposure and what measures they’ve been taking to stay isolated.
If you must take public transportation, you can use anti-viral wipes to disinfect your seat and any grabs bars, and wear latex or similar gloves which you can also cleanse with hand sanitizer if you cannot access a washroom. Once at the clinic, you may be asked to dispose of the gloves and to wash your hands.
About The American Macular Degeneration Foundation (AMDF)
AMDF is a patient-centered foundation that supports potentially game-changing Age-related macular degeneration (AMD) research, education and advocacy in order to improve quality of life and treatment outcomes for all those affected by AMD (macular.org). Contact us at 413.268.7660 or 1-888-MACULAR (1-888-622-8527)
About the American Academy of Ophthalmology (AAO)
The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, AAO protects sight and empowers lives by setting the standards for ophthalmic education and advocating for patients and the public. AAO innovates to advance the ophthalmic profession and to ensure the delivery of the highest-quality eye care. For more information, visit aao.org.
About Dr. Seddon
Dr. Seddon is a world-renowned retina specialist and genetic epidemiologist, recognized for her groundbreaking research on lifestyle factors , nutrition and the associations of these modifiable factors with macular degeneration. The advice to eat green, leafy vegetables, increase lutein and zeaxanthin intake, and adhere to healthy habits like not smoking and getting exercise, evolved from her early work which has changed the management of macular degeneration. She and her team also discovered many of the known genes related to macular degeneration. As Director of the UMass Macular Degeneration Center of Excellence she oversees patient evaluation and treatment. In addition to being a research scientist, Dr. Seddon also sees patients at several locations in Massachusetts.She co-authored the American Macular Degeneration Foundation’s cookbook “Eat Right for Your Sight,” based on scientific studies of the impact of nutrition on eye disease.
About Dr. Khurana
In addition to seeing patients, Dr. Khurana is active with clinical research in developing new treatments for various retinal diseases. He has published over 100 peer reviewed scientific papers, been honored with numerous national awards and involved in over 90 clinical trials. Dr. Khurana is heavily involved with the American Academy of Ophthalmology and the American Society of Retinal Specialists where he serves on many committees. He currently serves as the Editor-in-Chief of the Ophthalmic News and Education (ONE) Network, which serves more than 100,000 eye physicians and surgeons around the world. Dr. Khurana was recognized by the American Medical Association as one of the top 51 emerging national leaders expected to make a strong impact on the future of medicine.