Faced with a steep decline in visits due to the coronavirus (COVID-19) pandemic but a continued need to track intraocular pressure (IOP), physician-researchers in California developed a drive-through IOP screening clinic. Due to the screening effort, nearly a third of patients required a change in how their IOP was being managed, according to a research letter published in JAMA Ophthalmology.
Telehealth has been increasingly used during the pandemic, but IOP levels are difficult to measure via video technology, according to researchers. To continue to collect needed data to guide the care of patients with glaucoma, the team held a drive-through IOP clinic.
During the clinic, clinicians donned N95 masks, eye protection, and gloves while patients wore masks and stayed in their vehicles. Tonometry was performed in a parking lot. Tonometers were disinfected and single-use tips were replaced between patients. If a patient’s IOP exceeded a predetermined threshold, he or she was brought into the clinic immediately for Goldmann applanation. If pressure levels were unremarkable, the patient left and a follow-up visit via telehealth was used to discuss any necessary changes to therapy.
A total of 151 visits with 135 patients were conducted spanning 9 weeks. The median age of patients was 51 years. The mean IOP was 18.2 (6.3) mm Hg. Only 14 eyes (4.7%) were found to have 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 of 151 visits (30.5%) resulted in a change in management based on findings.
“The drive-through IOP clinic has proven to be a tremendous asset to clinical operations during the COVID-19 pandemic,” explains the study. “Although conceived out of necessity, this innovative approach to patient care may continue to serve our patients’ needs well beyond this crisis.”
Researchers note several limitations of their study, particularly the workflow. In some populations, patients rely on public transportation, so a walk-through alternative was created but not widely used. Inclement weather also may limit this design’s feasibility. Lastly, the drive-through clinic doesn’t allow for comprehensive ophthalmic care.
Disclosure: One study authors declared affiliations with the biotech or pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Sundararajan M, Nguyen AH, Lopez SE, et al. Adapting to coronavirus disease 2019 with point-of-care outdoor intraocular pressure monitoring. JAMA Ophthalmol. Published online January 7, 2021. doi:10.1001/jamaophthalmol.2020.6073