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Melbourne eyecare practitioners adapt services for Stage 4 restrictions

Broken spectacle replacements, essential OrthoK reviews, foreign bodies and intravitreal injections feature among the most necessary services Melbourne eyecare professionals are providing one week on from hardened lockdown restrictions.

The Stage 4 measures, which came into effect from 6 August and will remain in place until at least 17 September, have reduced optometry and ophthalmology service levels, with the overall aim of limiting people-movements across the city in a bid to reign in COVID-19 spread.

Optometry Australia (OA) received advice from government officials that optometrists and other AHPRA-registered health workers can continue to “provide services that prevent a significant change/deterioration in functional independence necessitating escalation of care”.

This could include a requirement for specialist input or review, an increase in care needs and/or alternate accommodation and avoiding a hospital admission or emergency department presentation.

“We believe this means that optometrists can provide urgent care and care that is necessary at this time to prevent deterioration of an established condition,” OA stated.

The organisation clarified that there is no requirement for a medical referral for patients to access optometry care, which came as a relief after this measure was stipulated in the first set of guidelines.

It also stated there was neither a geographical limit for patients to seek healthcare nor restrictions on telehealth services. OA is also developing tele-optometry guidelines.

OA is advising optometrists to:

  • Use their clinical judgement in determining what face-to-face care is appropriate to provide.
  • Postpone face-to-face services where doing so is unlikely to pose a risk to the patient’s eye health or impact the patient’s ability to function (work, drive etc).
  • Utilise telehealth wherever possible.
  • Cease routine recalls of patients and provision of routine care during this period.

Practices remaining open are required to have work permits for all staff for travel. Self-employed professionals are advised to sign both sides and carry a printed copy of their AHPRA registration certificate. Practices also need a COVID-Safe plan.

The Melbourne optometry landscape

Mr Steven Johnston, CEO of independent optometry network ProVision, said extremely positive June and July results have given most of its members cause for renewed optimism, even though “Stage 4 has set a significant section of its Victorian practices back on their haunches”.

“The majority of our Melbourne based optometrists are making themselves available for urgent and emergency cases, whilst ensuring that their practices are strictly adhering to a COVID-Safe plan,” he said.

“A few of our practices have chosen to close to eliminate all potential risk to all stakeholders.”

Optometrists are still able to provide replacements for lost or broken glasses that patients depend on.

Specsavers Australia has told Insight that as optometry has been defined as an essential publicly funded health service, the vast majority of its Victorian stores will remain open to assist patients and customers with their “urgent and essential” eyecare needs. A continual review by Specsavers of DHHS and AHPRA guidelines may alter this position, it stated.

The measures weren’t expected to impact essential delivery and collection of glasses or contact lens orders that were purchased before the hardened lockdown. Both in-store and contactless home delivery options are being employed.

Meanwhile, Mr Willy Gunawan, of Collins Street Optometrists, said the Melbourne CBD where his practice is located is like a ghost town, with patient numbers well down and their staffing reduced to 50%. He said this came as no surprise with reports of pedestrian traffic having fallen by 90% in the city.

Willy Gunawan.

In line with directions from the Victorian Chief Allied Health Officer, the practice is only providing services that “prevent a significant change or deterioration in functional independence necessitating escalation of care”. These services include “true emergencies” such as infections and sudden changes in vision, and circumstances where patients are no longer able to function, for example the loss or breakage of glasses that a patient is dependent on.

He said the Department of Health guidelines also mean the practice is specifically prohibited from providing routine eye examinations and services that are not essential in the lockdown period and can safely be delayed. These include non-clinical services such as looking for a new pair of glasses, browsing for new frames and almost all frame adjustments.

“The regular monitoring of chronic eye diseases such as cataract or glaucoma can usually also be deferred for the scheduled six-week period of Stage 4 lockdown. But in the longer term once the Stage 4 restrictions have expired, we reiterate recent government advice that people with chronic health conditions should not avoid clinically necessary reviews,” Gunawan said.

Elsewhere, Dr Philip Cheng, of Eyecare Concepts in Kew East, is seeing patients who require immediate care and reviews that shouldn’t be delayed by six weeks.

Optometrist Philip Cheng is an experienced contact lens practitioner with expertise in complex contact lens fitting, including OrthoK.

This includes corneal foreign body removals, which have risen with an increase in DIY work, referrals from GPs and patients who have lost or broken their glasses.

He is also continuing to see children who recently commenced on myopia control treatments like orthokeratology. These require several reviews at the start of the treatment program and he said it would not be advisable to delay these reviews for eye health reasons.

In terms of product orders, Cheng is continuing to fulfil contact lens reorders, contact lens solutions – especially specialty products not available at chemists – and replacing broken or lost glasses and OrthoK lenses.

Bailey Nelson announced some of its stores are conducting eye exams for patients with essential eye health or vision needs, in particular where deferring this appointment would have a negative impact on their ability to function day-to-day or be detrimental to their eye health.

It is still providing recommendations and dispensing single vision, progressive and contact lenses for customers with a valid prescription or following an eye exam in store, its website states.

It is also processing health fund claims for current or new prescription orders and conducting contactless service for repairs and adjustment. Free contactless delivery is available for orders that were already placed.

Bupa Optical has temporarily closed seven Melbourne stories until 13 September, and has kept its Camberwell and Bourke St City locations open for urgent care.

Elective surgery and ophthalmic consulting  

Meanwhile, after pausing all non-urgent elective surgery in metropolitan Melbourne on 28 July, the Victorian Government expanded the restriction to all of regional Victoria on 5 August.

Heather Mack.

The state-wide suspension is designed to free up bed space, equipment and staff for an influx in COVID-19 cases, which includes transfer of sick elderly people from aged care facilities.

Under Stage 4 restrictions, public and private medical specialists are deemed ‘permitted workers’ where urgent specialist consultation is required.

Dr Heather Mack, the RANZCO president and senior associate at Eye Surgery Associates in Melbourne, said with most elective surgery postponed, ophthalmologists would mainly continue to see emergency cases, perform intravitreal injections and patients who self-select.

Practices would continue to operate under strict hygiene precautions. Ophthalmologists and their staff also require permits to produce if they are stopped by the police more than 5km from home and are also expected to keep a travel diary to confirm travel is for work purposes only.

Ms Lara Helen, practice manager at multi-disciplinary ophthalmology clinic Bayside Eye Specialists in Melbourne’s Brighton East, has developed a COVID-Safe plan and requested all 10 ophthalmologists to triage their patients for the next six weeks. More than 1,000 appointments needed to be reviewed.

“We will continue providing essential and acute ophthalmic care including glaucoma, medical retina, infections, foreign bodies, squamous cell carcinomas. New referrals will be accepted for any acute cases, such as anything that is potentially sight threatening,” she said.

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