By Eric Weintraub
When Dr. Charles DeBoer, a second-year resident in the USC Department of Ophthalmology, learned that barrier shields meant to protect patients and physicians from COVID-19 droplet transfer were nationally backordered, he spent his own time and personal resources to build PPE customized for ophthalmic exams.
“I saw a barrier shield design in the paper, ‘Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong (2020)’ and thought the way they implemented infection control made sense,” said Dr. DeBoer. “So I copied it for our clinics and we refined the design.” In collaboration with co-resident Dr. Diana Lee and two attending physicians, Drs. Vivek Patel and Annie Nguyen, Dr. DeBoer created barrier shields out of polycarbonate sheets for slit lamps, the microscopes used to look into patients’ eyes.
Dr. DeBoer’s barrier shields now enable physicians to examine a patient closely while still reducing the risk of infection for them both at LAC+USC Medical Center (LAC+USC) and Keck Medical Center (KMC) ophthalmology clinics. This is only one example of how residents are adapting within the drastically disrupted learning environment due to the ongoing COVID-19 pandemic.
In addition, residents are continuously implementing the latest COVID-19 industry responses provided by the American Academy of Ophthalmology (AAO). They are strengthening their history taking skills to learn more about their patients’ health histories, and have increased in-depth provider-to-provider discussions with their fellow residents, fellows, and faculty. Furthermore, residents are learning how to use new technology to provide telehealth services to meet patient needs.
“Telehealth allows us to perform a quick external exam of a patient’s eye,” said Dr. Hong-Uyen Hua, a second-year resident. “While it does not allow for a full assessment, it can help patients avoid in-office visits for non-urgent issues.”
Dr. Hua elaborated that patients often call with eye problems that can be resolved over the phone. Several patients who tested positive for COVID-19 have called with concern that they are developing an eye infection, as well. “In this situation, we ensure that the patient has no vision-threatening issues. We educate and counsel them on supportive care, emphasize the importance of social distancing, and make sure they practice good hygiene. As a result, we minimize exposure for everyone.”
Several residents expressed their belief that COVID-19 will permanently affect the ophthalmology landscape and that it has opened the door for telemedicine to play a more frequent role in the field.
Due to the California Governor’s Executive Order, as well as LA County requirements, clinic volume has been drastically limited to only treating patients with emergency eye conditions. The residency program has taken additional measurements to decrease the likelihood of a COVID-19 infection by having residents rotate in teams at LAC+USC, one week on and one week. In addition, KMC clinics are only seeing urgent patients and all elective surgeries have been canceled. Due to these changes, residents are not rotating in Keck clinics.
“The education and experience we get from seeing patients and operating on them has drastically declined,” said Dr. Ravi Shah, a third-year resident and co-chief resident. “This is likely going to affect different years of residents in different ways. For those that take advantage of the time to continue learning, it may be beneficial for them. But without that motivation, knowledge will quickly atrophy.”
Dr. Shah shared that away from clinic, residents are reading journal articles to stay updated on their respective fields and studying for their annual Ophthalmic Knowledge Assessment Program (OKAP) exams. In addition, the residency program’s education curriculum has quickly shifted to online learning. All faculty lectures and Grand Rounds continue to be conducted via Zoom.
Despite the disruption that COVID-19 has caused to the residents’ training, they share great pride in their colleagues’ resilience. “Too often likened to war, this pandemic has heroic troops battling this microscopic, insidious enemy every day,” said Dr. Hua. “When we chose medicine as a career, no healthcare worker imagined we would have to risk our own lives to save others. I am in awe of all of my colleagues on the frontline. I feel re-affirmed in my decision to choose medicine as a career and vocation during this unprecedented pandemic.”
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