December 2020

ASCRS NEWS

ASCRS leadership reflects on 2020


Our main practice and four satellite locations at Virginia Eye Consultants have been back online since the beginning of May. It took about 8 weeks for us to get close to 90% pre-COVID volume. There are unique challenges that we have prepared and accounted for, and this continues to evolve in order for us to meet the various challenges. There was some staff turnover, in part driven by personal challenges with childcare and virtual schooling. I was surprised to see how quickly patient volume has recovered to almost pre-COVID volume. In order to respect social distancing and the extra disinfection protocols, more time has been built into the schedules between patients. In order to accommodate the patient volume, creative adjustments to the schedule are being made, which includes starting clinic earlier, minimizing breaks between morning and afternoon patient clinics, sometimes ending later in the day, and changing follow-up appointment protocols. We turned our postop day 1 routine cataract surgery follow-up appointment into a virtual visit. This required a change to patient postop regimens, which now includes one dose of oral acetazolamide in the recovery room and the addition of brimonidine twice daily for 1 week after cataract surgery. Our threshold is very low for bringing patients back into clinic for any concerns of disproportionate blurring of vision or pain. This has been hugely popular and well accepted, and we have not yet experienced any undue surprises at the postop week 1 visit.
It is interesting to see what is driving the patient volume. The “mask” phenomenon is a real challenge for younger and older patients alike. The demand for LASIK evaluations has increased significantly because of spectacles fogging up from the masks. On a positive note, this has led to a greater pool of healthier ocular surface LASIK evaluation patients, specifically those who only wear spectacles and are not coming in due to contact lens intolerance issues. Furthermore, some patients whose days are spent on Zoom are aware and self-conscious of their appearance, including their desire to see themselves spectacle-free during video communications. For older patients, real estate around the ear has become more crowded with the mask, spectacles, and the commonly utilized hearing aid. Additionally, the uncertainty of the near future with COVID-19, including vaccines and future waves of greater disease spread, has created a more palpable emotional undertone with patients. Some are extremely grateful for medical professionals, others have greater fear and anxiety, and others are downright angry. This has led to greater empathy exhaustion, and in general, staff and clinician morale is not as stable or as high as it was in 2019. We will have to do what we can to promote work harmony and mitigate burnout. I am hopeful that COVID will become a distant memory soon with effective vaccinations and treatment options. Until then, we will continue to adapt to our current reality. While we are taking care of a “more normal” routine patient volume now both medically and surgically, the next months will bring forth greater insight into this as the cold weather settles in. The same goes for live meeting opportunities. While virtual learning provides a convenience, nothing compares to the variety offered at onsite, live meetings with the networking, camaraderie, and varied forms of education platforms. While meetings may attempt to go live in early 2021, attendance will likely be low for at least the first half of the year. The first viable live meeting with a more “normal” attendance will likely be the 2021
ASCRS Annual Meeting in August. That can’t come soon enough!
Elizabeth Yeu, MD
ASCRS Secretary


We U.S. ophthalmologists are now entering our seventh month of dealing with the COVID-19 pandemic. In March and early April, patient volume and revenue in ophthalmology were reduced more than any other medical specialty. Our primary revenue-producing procedure, cataract surgery with IOL implantation, was down 96%. Since May, office-based and elective surgery volumes have been recovering. Private office practice and ASC elective surgical volume has recovered faster than institutional office practice and HOPD-based surgery. In our practice in Minnesota, our volumes have recovered, but we are facing several challenges. The need for screening prior to entry into the office or ASC, increased cleaning between cases, and use of PPE has increased overhead. COVID-19 has negatively impacted employee, administrator, and doctor morale, with many at-home and at-work changes challenging most. Personally, I find the practice of ophthalmology harder and less fun. Many senior ophthalmologists agree and have found COVID-19 to be the catalyst that has driven them to accelerate retirement. Yet the need for quality ophthalmologists to help patients preserve, restore, and enhance their vision is greater than ever. In terms of cataract surgery, we have a 1.5 M case backlog to erase. On a positive note, our practices and the major societies like ASCRS and AAO have adapted and survived. We have learned how to provide quality virtual education for our colleagues and safe in-person and telehealth care for our patients. Our partners in industry have been supportive. If we avoid a second surge of infections and a major recession in 2021, ophthalmology will continue its strong recovery. If COVID-19 surges again and we have a major economic downturn, we will be further challenged and some practices may fail, but as a whole, we will survive, as quality vision is critical to our patients and our society in general. I am an optimist but as a realist am preparing for further challenges in 2021. 

Richard Lindstrom, MD
ASCRS Member at Large


Ophthalmology was one of the most affected specialties of medicine by the COVID-19 pandemic. However, the global crisis highlighted some of the best qualities of the members of our field—responsibility, heroism, dedication, and professionalism—with responses ranging from closing down one’s practice to redeployment to in-patient medical units. None of these alterations were easy for our members. As offices and practices were allowed to reopen, we have seen the dynamic adaptability of our members and their teams, as well as the importance that vision holds for the patients we are privileged to serve.

Douglas Rhee, MD
ASCRS Treasurer

 

2020 will certainly be a year to remember. All of our lives were (and continue to be) impacted as a result of the COVID-19 pandemic. Day-to-day practice has required new protocols. We administer questionnaires and temperature checks for all those entering the clinic. Masks are mandatory. Examination rooms and equipment are wiped down between each patient. Non-essential patient visitors are asked to remain outside. Social distancing is strictly enforced, with more than half of our waiting chairs blocked off. Despite the initial fear that our productivity would not bounce back, we have seen a near normal return of volume both clinically and surgically. That being said, there are still many patients who are fearful to seek care, and I do worry that there will be some morbidity that occurs because of this.  
From a professional education and society point of view, I was proud of the ASCRS staff and leadership who were able to abruptly pivot to a virtual annual meeting. Out of necessity and an abundance of caution, it was one of the first of many virtual meetings. At this point, I am experiencing Zoom fatigue. I wonder how long industry will be willing to support virtual meetings, as their ability to interact with attendees is limited. I am optimistically looking forward to the possibility of in-person meetings in 2021. I miss interacting with my friends and colleagues. Most of all, I look forward to the ASCRS Annual Meeting in San Francisco in August. I think that this meeting will happen and will be conducted in a safe manner while providing excellent educational and social opportunities like we have become accustomed to from the ASCRS Annual Meeting.

Sumit “Sam” Garg, MD
ASCRS Young Eye Surgeons Committee Chair


The year 2020 will never be forgotten for many reasons. The COVID epidemic has impacted our families, our friends, and our workplace. In addition, it has affected the way we learn and obtain our education. The innovations in virtual meetings have been an excellent way to connect and continue the teaching and learning we have all wanted. As much as these virtual meetings have been appreciated, they are not a substitute for live, in-person meetings. I have heard from many of our members about how they are looking forward to the next real meeting. It appears that the next major ophthalmic meeting will be the 2021 ASCRS Annual Meeting. Due to COVID and the risk of canceling our meeting again if held in our usual spring slot, our leadership made the decision to move the annual meeting to August. We are optimistic that this meeting will happen live. The Program Committee is already hard at work assembling an outstanding educational event with new and unique programming to make this meeting exceptional. Please block your calendar for the 2021 ASCRS Annual Meeting, August 13–17 in San Francisco. I look forward to seeing you there in person!

Edward Holland, MD
ASCRS Program Chair

ASCRS leadership reflects on 2020 ASCRS leadership reflects on 2020
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