PracticeUpdate: Before we discuss changes because of the COVID 19 epidemic, what techniques do you use for the diagnosis and monitoring of wet AMD?
Dr. Li: At the beginning for the diagnosis of wet AMD, I prefer for the patient to have a fluorescein angiogram, our ICG angiogram just the once. Then just followed by OCT unless [there’s] some very ambiguous finding and we are not sure whether this is a flare-up or recurrence again. We may use this angiography again, but very seldom, now, today, in the clinic.
I use a fluorescein angiography much more than the ICG, except for some variant of wet AMD called polypoidal choroidal vasculopathy, PCV. I use ICG angiography to confirm, otherwise, for each patient, normally we just use FA at the beginning then followed by OCT.
PracticeUpdate: How should these protocols be modified during the COVID-19 epidemic?
Dr. Li: That's a very important question, and a good question for us now. Since the COVID crisis, we are only treating the urgent cases for some most stable and routine exam patients, we are postponing. This is what our clinical number for the patient waiting now is at 15-20% of our original schedule. But now, just these 2 weeks, the number is starting to get higher. The criteria, we are seeing the urgent, meaning if we schedule the patient for treat extended patient when they got the date. If their health condition permits, meaning we put life-threatening COVID first. Then we consider the sight-threatening, like wet AMD, second. If the condition permits, if the patients have people… [to] transport them to the office, we will schedule them.
If patients stay in the nursing home, the condition's not stable, we talk to the patient, we say that the life-threatening problem, we have to put it the highest priority, even though you have symptoms. Even though visual condition may be getting worse, we have to postpone the visit.
PracticeUpdate: For the patients who do need to come into the clinic, what precautions do you take?
Dr. Li: If we decide the patient can come to our office, then for the visit we put at least half hour apart between the visits, to make sure the patients come to the office, just himself or herself to be registered by our protected staffs. Then send the patient to a room just by himself for the OCT, and including only the visual field examination, then to a separate room and wait for injection. We minimized even the retina examination in most of the people if we look at the OCT and it's relatively stable, no big change, and all the vision is relatively stable. We try to minimize the time in the office, as well.
The patient also will be provided a face mask and so, and in some very special occasion, if the patient needs bilateral injection, and the timing for the injection for both eyes are close, we minimize the visits and give him bilateral injection, but that's a very, very rare condition for that.
PracticeUpdate: Finally, what recommendations do you make for self-monitoring?
Dr. Li: The self-monitoring both dry and wet for the patients is still based on their own symptoms and Amsler self-examination. That means if they feel the visual acuity is getting blurry and when they look at the grid, Amsler grid, they find a… new distortion, new scotoma, they document that, they call us… before we reschedule them, we call them to make sure the condition is changing or stable and we still can keep the original schedule or not. Totally based on their own symptoms described.