How the virus is transmitted
As it is a new disease, transmission of COVID-19 is not yet fully understood, but we believe that coronaviruses are mainly transmitted by someone coming into contact with respiratory droplets or – directly or indirectly – with infected secretions. It is potentially transmissible through contact with aerosol droplets from the tears of infected patients. Isolation, standard cleaning and disinfection should be practised to help prevent transmission.
The aim of this guidance is to help you to continue to run your practice by adapting it to make it as safe as possible for you, your staff and your patients and reduce the likelihood of contracting or spreading the virus. As more is learned about the virus, and its transmissibility (or not) in optical practice, it is likely that this guidance will change, so please check back regularly for updates.
2. Adapting your practice
- Lock the door so that patients are seen by appointment only.
- Maintain social distancing.
- Space out the chairs in the waiting and dispensing areas.
- Limit the number of people in the practice and consulting room at any one time by spacing out appointments.
- Ask patients to use their own pen to sign any forms, or sanitise any pen used. Similarly, sanitise any clipboards that patients touch when signing forms.
- Use a cough guard on your slit lamp. The Royal College of Ophthalmologists has advice on how you can make a temporary cough guard here.
- Wear a surgical mask when examining or treating patients at the slit lamp. The same surgical mask may be worn for examining multiple patients, but you must be fastidious to avoid transmitting the virus on the front of the mask via your hands or your clothes. Do not take the mask on and off between patients and do not allow it to dangle on your chest. Instructions on how to put on and take off PPE can be found here.
- Wipe clinical equipment and door handles after every patient, as well as other surfaces that may have been contaminated with body fluids using a suitable disinfectant such as an alcohol wipe. All surfaces must be clean before they are disinfected.
- Sanitise frames before patients try them on. If you need to focimeter patients’ spectacles, ask the patient to take them off and provide the patient with a wipe to sanitise their frames before you touch them.
- Support good tissue practice (catch it, kill it, bin it) for patients and staff by having tissues and covered bins readily available.
- See patients by appointment only, and only those who have urgent eye or sight-related symptoms which cannot wait. These may be patients who would be seen using a MECS-type service, or sight tests for symptomatic patients where these are clinically necessary and cannot safely be postponed. Do not see patients without eye or sight related symptoms for routine sight tests. We have a poster you can display so patients know how to contact you.
- Use a telephone or video triage system to determine whether a patient needs to be seen. The GOC has issued advice on issuing spectacles and contact lenses to patients who are overdue for their appointments and we have a template available here.
- As part of the triage, ask patients to confirm that they are well and that everyone in their household is not exhibiting relevant symptoms (new, continuous cough and/or a high temperature). Patients with these symptoms should not attend the practice, and should self-isolate.
- Ask patients to decontaminate their hands on entering the practice by providing them with a hand sanitiser or hand washing facilities.
Reduce physical contact
- Adapt your routine to reduce close contact with patients. For example using SL-BIO instead of direct ophthalmoscopy, or fundal imaging if that is an acceptable alternative.
- Have any discussions with the patient (e.g. symptoms and history, advice given) at a safe distance.
- You should use good hand hygiene before and after any patient contact, but try and avoid touching the patient where possible. For example you could ask the patient to open their eyes wide when looking down doing SL-BIO, or use a cotton bud to lift their lids if you need to do so.
- Other things you can do to minimise physical contact with patients include:
- asking the patient to remove their spectacles themselves rather than you doing it
- asking contact lens patients to insert and remove their lenses themselves (if possible), rather than you doing it,
- asking patients to pull their lower lids down themselves if you are instilling eye drops, or using a tissue between your finger and their lids if you need to pull their lid down.
- We anticipate that you will only need to refract patients rarely, but if you do need to do so, use your professional judgement to decide in how much detail you need to refine your refraction, in order to minimise the time spent close to the patient. For example, do you really need to worry about the 0.25 cylinder?
- If you do need to touch the patient be particularly scrupulous about your hygiene before and after touching the patient, and ensure you decontaminate any equipment used appropriately.
Aerosol generating procedures
- Because of the risk of aerosols or splashing of tears, do not use air-puff tonometry. If you normally use air-puff tonometry, consider whether this is really needed. For example if the patient has normal discs and visual fields then do you need to measure their IOP? Although they will not produce aerosols, similar considerations would apply if your only method of tonometry is using a Perkins or iCare tonometer, because of the close contact with the patient that is required.
- Because of the risk of aerosols, do not use Alger brushes. If you need to remove a rust ring, use a needle instead.
Referrals and dispensing
- Consider your referrals carefully. Non-urgent patients are unlikely to be seen in the hospital for many months, so would it be better for you to monitor them in practice instead? For example, if you would normally refer a patient for cataract and postpone dispensing their spectacles until after surgery, it may be better to discuss with them whether it would be worth them having their spectacles updated as they will have to wait longer than usual for surgery.
- Consider whether you need a patient to come in for dispensing. If they simply need a reglaze or have broken their specs – can you repair or reglaze them by post, or make a duplicate pair from the information you already have on file?
- If the patient needs new spectacles, post these to the patient rather than asking them to come in for collection.
- Remember to make it clear from your clinical record that the patient was seen during the COVID-19 pandemic, to help explain your decision making where necessary.