Aging and Eye Diseases—Providing Care During the Time of Coronavirus

Special Guest:
Carol Schwartz, MD, FRCSC, DABO, Assistant Professor, University of Toronto, Ophthalmologist, Sunnybrook Health Sciences Centre, Toronto, ON.

D'Arcy Little, MD, CCFP, FCFP, FRCPC, Medical Director, JCCC and, Toronto, ON.
Aly Abdulla, MD, CCFP, FCFP, DipSportMed CASEM, CTH, CCPE, McPL, Family Physician, Ottawa, ON.

Michael Gordon, MD, MSc, FRCPC, FACP, FRCPEdin; Geriatrician and Ethicist, advisory board member JCCC and, Toronto, ON.

Marina Abdel Malek, MD, BScN, Family Physician, advisory board member JCCC and, Toronto, ON.

The following questions were not answered during the live event as we ran out of time:

As ophthalmologists/retinal specialists, we have all cancelled everyone except for those cases that we consider "urgent". Each of us may have our own definition of what is considered urgent. Although diabetic macular edema is treated with anti-VEGF injections, it is a different disease than wet AMD. While wet AMD can progress very quickly if injections are missed or delayed, vision loss from DME is usually at a slower rate and even if treatment is delayed, any subsequent vision loss can often be regained when treatment is resumed. For that reason, many specialists are trying to delay injections in patients with DME, especially if they are elderly or have any other systemic risk factors that would put them at added risk of catching the virus. That being said, if you or your patient is concerned about missing injections or is experiencing vision loss, my advice is to contact the treating physician so that appropriate follow-up can be arranged.

A blocked nasolacrimal duct can be opened by probing but this is not being done at this time as it is an elective office procedure that is aerosol generating. Supportive measures such as artificial tears and warm compresses during the day and Lacrilube ointment at night may offer some symptomatic relief until a consultation with the specialist can be arranged.

The frequency of injections for DME varies from patient to patient. There are different treatment paradigms that have been studied and each physician has their own strategy. Injections are often started on a monthly basis and continued for at least 5 or 6 injections until the macula and visual acuity is dry and stable. At that point, treatment may be stopped to see if the DME recurs. As Diabetes is a chronic disease, the edema often recurs and at this point, further injections would be given using individual maintenance schedules to try and control the edema with as little treatment as necessary.

The Following Questions were answered during the live event and you can watch the recording:

  • How has your practice changed since the coronavirus?
  • Do you expect that there will be a lot of backlog once restrictions are eased?
  • What advice, if any, can family doctors give patients about what they can do to prevent complications related to macular degeneration?
  • What are the risks of delaying/postponing continued treatments for wet macular degeneration for LTC residents (life expectancy <2 years) during COVID-19 outbreak, given that these residents and co-living residents may be placed at increased risk of harm if exposed to virus outside of nursing home?
  • How can Telemedicine be utilized to deal with eye problems during the Covid Pandemic?
  • What eye symptoms would warrant a trip to the ER despite the coronavirus threat?
  • How do I manage an acute red eye when I can’t see the patient?
  • Any advice on managing conjunctivitis during Covid?
  • How often should we be sending asymptomatic patients for eye examinations?
  • What services are covered by OHIP? (within Ontario)
  • What issues should be sent to Optometry vs. Ophthalmology?
  • What are the implications of missed injections for wet macular degeneration?
  • Anything new on the horizon for dry macular degeneration?

As the world grapples with the challenges as a result of the COVID-19 pandemic, people are not spared from other illnesses and require services vital to their health. 

Often patients who have serious problems with their vision need continuing care. There are no "cures" for such diseases as wet Age-related Macular Degeneration (wAMD), Diabetic Macular Edema and Glaucoma that require ongoing visits to the eye specialists for treatments. These conditions mostly affect older, often frail people who require assistance from family members with attending their appointments.

How are these procedures performed during the pandemic and are the patients and their caregivers safe attending their medical appointments? What is the role of Family Doctors?

These and other questions are going to be tackled during our Live Panel discussion with our distinguished guest Dr. Carol Schwartz, FRCSC, DABO, Assistant Professor, University of Toronto, Ophthalmologist, Sunnybrook Health Sciences Centre, Toronto, ON

This learning program is geared towards primary care physicians, educators, and other health care professionals. The attendance is free with registration.

This eLearning module fits within the Mainpro+ Self-Learning Activities Section. You may submit this non-certified* activity for one non-certified credit per hour.

*Non-certified activities have not been formally reviewed by the College but comply with the College’s definition of CPD, are non-promotional in nature, and provide valuable professional learning opportunities.

Views and opinions in this program are of the faculty and not necessarily endorsed by, or reflective of, those of the publisher of and Journal of Current Clinical Care.

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