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Like most doctors, the majority of optometrists closed their offices to routine care. Some opened to emergency cases, but only if they had the clinical skills and community reputation to make it work. Practices that rely too heavily on refractions and are mostly perceived as an outlet for glasses fared poorly. One of our number—Patrick Vollmer, OD—made the transition easily. Urgent care was nothing new to Dr. Vollmer, who provided emergency eye care the first day he walked in the door of his practice, long before COVID-19 struck. “I worked tirelessly in my community to establish medical and emergency eye care,” he says. “This has proven to be a virtuous decision. To my knowledge, pretty much all of the hospitals, Urgent Cares and primary care offices are a bit overwhelmed with the COVID-19 response. They don’t want to deal with eye issues right now. A lot of these patients are getting funneled into my clinic day and night.” He sees each patient one at a time, so there is never more than one patient in the clinic. To further ensure safety, Dr. Vollmer wears an N-95 mask and gloves, and all patients also receive masks and gloves at the door. When the patient leaves, everything is disinfected. The procedure is a bit tedious “but it works,” he says. Many of Dr. Vollmer’s current emergency patients tell him they would’ve normally gone to the ER or Urgent Care, but they were worried about being in a hospital setting currently. “I take this opportunity to educate these new patients that they shouldn’t go the ER anyway. A lot of patients simply don’t know this despite going to their eye doctors for years. Optometry cannot assume patients know to come to their clinics for ocular emergencies,” he says. Patients are appreciative of emergency care regardless, but they are especially grateful during this outbreak, Dr. Vollmer says. “I don’t charge an after-hours fee right now, and the most I charge for any office visit is around $150 if they have no insurance or a high deductible. It’s nice to be appreciated, but I get more fulfillment in knowing I helped someone in need.” Continuing to see patients who called in for urgent issues filled a critical patient care need and kept Dr. Vollmer’s practice busy during the downtime. “One of the important aspects that I learned,” he explains, “is how important it is to diversify your practice. If it wasn’t for emergency patients and ‘urgent’ needs, life would have been pretty slow.” Now that the practice is seeing routine care again, patients are more motivated than ever to come in because they know this is a doctor they can count on even in the toughest times Every patient is unique, and deserves to be treated as such, but these tips have proven correct again and again in numerous encounters the three of us have amassed throughout our careers. • If there is any unexplained alteration of visual function, always do a retrospective review of any changes of the patient’s medicines, especially if they are on any new medicines or changes to dosing have been made. By doing so, often a cause-and-effect relationship can be established that provides a rational explanation for the change in visual status. • Studies have confirmed that patients prefer their doctors to wear a lab coat with their nametag on it. We prefer our nametags to have our first and last names, then OD, rather than “Dr. Last Name.” We are proud to be ODs, and on occasion, it provides an opportunity to explain to our patients exactly what an OD is. To display our degree allows us to share our unique expertise in eye care, and to confirm to our patients that they are, indeed, seeing the right doctor. Be proud to be an OD! • Unless the cause for foreign body sensation is clearly evident (and sometimes even when it is), always evert the upper eyelid after instilling fluorescein dye. There is always a cause for foreign body sensation, so look for things like: – subtle epithelial basement membrane dystrophy – Thygeson’s superficial punctate keratopathy – eroding tarsal conjunctival concretions – occult trichiasis – a loose lash in the puncta For conjunctival foreign bodies, we try not to use an anesthetic, so once the foreign body has been removed, the patient can give immediate confirmation of relief, rather than having to wait 20 to 30 minutes while the anesthetic wears off before making such a determination. • If the eye is pretty much white yet the patient has miserable, irritated eyes with foreign body sensation, always think about superior limbic keratoconjunctivitis (SLK).
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