Outdoor Intraocular Pressure Screening Clinic Boosts Patient Management During Pandemic

By Marilynn Larkin

January 14, 2021

NEW YORK (Reuters Health) - A drive-through intraocular pressure (IOP) screening clinic minimized COVID-19 exposure for patients and clinicians by enabling eye pressure measurements in a clinic parking lot.

Researchers say the protocol is allowing clinicians to continue managing patients with vision-threatening diseases during the pandemic.

"We feel lucky to have had the infrastructure in place to launch this innovative clinic when we did," Dr. Miel Sundararajan of the University of California, San Francisco told Reuters Health by email. "Since its inception, we have seen many similar clinics take effect."

"Other sites at our institution, for instance, quickly followed suit," she noted. "Eye pressure can be very quickly assessed in most cases, and thus we would expect this type of clinic to be easily scalable. Long term, however, eye pressure cannot be the only data point to guide a patient's care, and a complete ophthalmic exam is required. This is one limitation in the utility of the drive-through setting."

As reported in JAMA Ophthalmology, patients in the drive-through IOP clinic were scheduled with consecutive appointments to optimize workflow. Clinicians wore N95 masks, eye protection, and gloves. Patients wore masks, remained in their vehicles and provided identification.

Tonometry was performed using the Icare ic200 and TA01i model rebound tonometers (Icare Finland Oy), which were disinfected before each use; single-use tips were replaced between patients.

If eye pressure exceeded a predetermined threshold value, the patient was brought into the clinic immediately for a Goldmann applanation.

If eye pressure levels were unremarkable, the patient left and any changes in therapy were discussed in a follow-up telehealth session.

One hundred and fifty-one visits with 135 patients (median age, 51; 61% women) were conducted over nine weeks. Indications for the visits included long-term topical steroid use, uveitis, chronic corneal disease, glaucoma and ocular hypertension.

The mean IOP was 18.2 mm Hg. Fourteen eyes (4.7%) had a pressure greater than 30 mm Hg.

Of the eyes exceeding screening IOP thresholds, 5 (36%) had a pressure greater than 30 mm Hg on repeated measurement by applanation.

Overall, 46 (30.5%) of the visits resulted in a management change based on the findings.

The authors conclude, "Although conceived out of necessity, this innovative approach to patient care may continue to serve our patients' needs well beyond this crisis."

Dr. Sundararajan said, "I am sure that the drive-through option could be translated to other subspecialties - blood pressure, for instance, could be checked in the clinic parking lot to identify patients at high risk for urgent complications."

"In general, this clinic served us well during the onset of the pandemic," she added. "It allowed us to identify patients at risk of imminent visual loss without placing patient or practitioner health at undue risk. With an organized team and attention to safety practices - i.e., adequate PPE - such an expedited outdoor clinic can be very effective."

Dr. Louis Pasquale, Chairman of the Department of Ophthalmology at The Mount Sinai Hospital in New York City, commented in an email to Reuters Health, "I refer patients to a rental service that provides them with a self tonometer. Drive-through services work well where the weather is good and there is an abundance of space. In areas like New York City, neither is the case and these drive- through services are not practical here."

SOURCE: https://bit.ly/3iciNWp JAMA Ophthalmology, online January 7, 202