key: cord-1030964-1nx7irye
authors: Bhartiya, Shibal
title: Current Glaucoma Practice: The Covid-19 Impact
date: 2020
journal: J Curr Glaucoma Pract
DOI: 10.5005/jp-journals-10078-1275
sha: 902efc3065bb9c7e3b4619af5f99bf842219efcb
doc_id: 1030964
cord_uid: 1nx7irye

How to cite this article: Bhartiya S. Current Glaucoma Practice: The Covid-19 Impact. J Curr Glaucoma Pract 2020;14(1):1–2.

visual fields until disinfection protocols are formulated, we could accept optical coherence tomography (OCT)-only algorithms of glaucoma diagnosis, but only if we are ready to shut away the structure vs function paradigm we have believed in. 4 Will we treat more ocular hypertensives in the absence of visual fields, or less? Will the red-green disease be the new glaucoma pandemic? Will we do less surgeries or more, if we choose the less invasive surgeries over conventional incisional surgeries? Will minimally invasive glaucoma surgery (MIGS) and tubes finally come of age, replacing trabeculectomies?

But glaucoma practitioners are no strangers to ambiguity: we have harped on the art of glaucoma for long. The numbers were there to aid us: in mm Hg, decibels, and microns. Suddenly, there will be fewer absolutes to fall back upon, fewer progression analyses, fewer slopes and triangulations. There will be filters that fail, intraocular pressures (IOPs) that decompensate, and visual fields, if and when we can do them, that deteriorate. There will be decisions to be taken, a strange new triage, and definitely more novel data points in the clinical paradigm than ever before. 5 In all this, there will be questions with correct answers, those without any answers at all, and there will also be questions we will fail to ask: clinical and ethical. We will see colleagues falter and we will see our own mistakes come back to haunt us 6 weeks or 6 months or 6 years from now.

That's just the science. New line items in variable costs and fewer patients absorbing rising fixed costs will mean higher cost of glaucoma care. Disposable equipment, PPE, staggered staff timings, fewer patients in the clinic, fewer procedures, fewer surgeries, waste management: the list is long. 6 So how do we navigate this? First, know that you are not alone. We will, all of us, stumble, sometimes we will hesitate, and sometimes we will look for the unsaid that guides many a glaucoma consult. And that there will be times when we will need to see our patients and not just their eyes or eye pressures. 7 There will be other times when a hug, or a longer handshake, is the only answer. It is then that we will need to draw on reserves of strength that exists within us, unseen or otherwise. We all well know that the cure of the disease is actually worse than the disease itself. And that's why so much of what we do in glaucoma is nonverbal communication; it is a relationship born of absolute trust.

Our patients will need to see our faces-and not only through acrylic slit lamp shields, or through face masks, or on computer screens. There will be times when we will need to see them smile, and when we will need them to see our smiles-for successes will be ours too. And there will be a time when we will.

Our calling has always been to preserve the quality of life in a bad disease. The premium on this purpose is even higher today. Long after we are gone, history will judge us not by our science, but by the kindness with which we protected those who needed us most.

The Spanish influenza pandemic: a lesson from history 100 years after 1918

Ophthalmology and glaucoma practice in the COVID-19 Era

Sustainable practice of ophthalmology during COVID-19: challenges and solutions. Graefes Arch Clin Exp Current Glaucoma Practice Journal of Current Glaucoma Practice

Quality of life in glaucoma: A review of the literature

Health economic analysis in glaucoma

Telemedicine for glaucoma: guidelines and recommendations

Relating optical coherence tomography to visual fields in glaucoma: structure-function mapping, limitations and future applications