As states start to reopen, some optometrists and ophthalmologists will begin to allow elective procedures—but should you wait a bit longer before your checkup?

By Kasandra Brabaw
May 22, 2020
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Weeks ago, it was unlikely you’d be able to get into the eye doctor for your annual checkup. Under recommendations from national health organizations like the Centers for Disease Control and Prevention, the American Optometric Association (AOA), and the American Academy of Ophthalmology (AAO), optometrist and ophthalmologist offices were open for emergency appointments only and people all over the country found themselves postponing annual checkups.

While visiting the eye doctor might not seem as risky as visiting a dentist—and certainly not as risky as a trip to the ER—eye doctors still had a reason to be cautious. The virus that causes COVID-19 is spread mainly through respiratory droplets shot through the air when an infected person coughs or sneezes, which makes it dangerous when eye doctors have to hover inches away from patients’ faces in order to examine them. 

But now that many states in the US have begun opening doctors’ offices for elective services, should you rush to schedule a checkup with your eye doctor or wait it out a little longer? And what if you have an eye emergency—how safe is it to see an ophthalmologist or optometrist?

How safe is it to go to the eye doctor right now?

“The eye doctor is as safe as any other doctor’s office,” says Gareth Lema, MD, PhD, a retinal surgeon at the New York Eye and Ear Infirmary of Mount Sinai. What that means really depends on the precautions your eye doctor is taking to reduce the risk of contracting COVID-19, so Dr. Lema recommends calling the office to ask about new procedures in place. But generally, all optometrists should be following guidelines from the AOA, AAO, and the CDC, such as pre-screening patients for COVID-19 symptoms and asking patients to wear masks. 

Of course, some people can be carrying the virus but not showing any symptoms, so precautions like pre-screening aren’t foolproof. And while the virus mainly spreads through respiratory droplets, there is some preliminary evidence that it can be present in the eyes, too (though the research was published in a pre-print, non peer-reviewed server). 

“There have been some really infrequent cases of conjunctivitis that may be related to coronavirus,” Dr. Lema tells Health. “But as far as I know, that's not a main cause of transmission.” Conjunctivitis is an infection in the eyes that can sometimes result from a virus. It’s named for the mucus membrane that covers the front of the eye and lines the inside of the eyeball. 

The structure of the eye is one reason it’s a vulnerable point in terms of contracting COVID-19, according to the AOA. “The eye is highly vascularized tissue (meaning it has a lot of blood vessels) that is in very close proximity to the sinuses and the brain, which makes it an easy entry point for viruses,” says Barbara L. Horn, O.D., president of the American Optometric Association. Because of this, COVID-19 can enter the body through the eyes and then spread to the rest of the body through the blood vessels in the conjunctiva. 

Knowing these risks, doctors offices, including eye doctors, have changed the way patients and doctors interact to ensure everyone is as safe as possible.

What are optometrist and ophthalmologist offices doing to protect patients from COVID-19?

No doctor and no set of state recommendations is the same, so the precautions taken at your own eye doctor's office will vary from place to place. Yet, Dr. Lema has noticed most of his colleagues implementing certain safety measures in the era of COVID-19. 

First, and most obvious, is that doctors, staff, and patients are all required to wear masks. “And if the patient's not wearing a suitable mask, then they'll have a surgeon's mask available for them to wear,” he says. Given that an eye doctor has to lean in close to your face to look at your eyes, masks keep everyone safe from droplets that can wander out of your nose or mouth even when no one coughs or sneezes. 

And although social distancing isn’t possible once you’re in the midst of an exam, optometrists’ offices are doing their best to keep patients far away from each other. Most offices are only allowing a few patients in at a time, Dr. Lema says, and many are keeping the patients in separate rooms so they never cross paths. “So basically, your home base would be the exam room and then you're brought out [one at a time] for imaging,” he says. 

Some offices are also asking patients to complete paperwork ahead of time so they spend less time in the waiting room, the AOA says. Your office might also ask you to wait in your car, if possible, until the doctor is ready for your exam. And while you may have once tried to small talk with your eye doctor as they looked into your eyes, the doctor might now ask that you not speak until the exam is over (this prevents any unnecessary respiratory droplets from leaving your mouth). 

To protect themselves, some eye doctors have started using larger plexiglass sheets in the slit lamp machine used to look into patients’ eyes. Typically, these machines come with a plastic shield about the size of an index card, Dr. Lema says. But lately, doctors have been switching out that sheet for one the size of a standard sheet of printer paper. The larger size further shields the doctor and the patient from virus particles that could pass from one to the other. 

Hand hygiene is also important, of course, but beware that many offices will ask you to remove gloves you’ve worn in from outside. “This really is for everyone's protection,” Dr. Lema says. “Put simply, gloves only protect your fingers.” Protection is great, but if you’re wearing gloves all day and touching contaminated surfaces you can easily infect anything else you touch, including your face or your mask. Dr. Lema’s practice at Mount Sinai is mandating that everyone who wears gloves from outside of the office take them off, and keep them in their pocket or throw them away. 

So when can you schedule your next appointment with an eye doctor?

Regular checkups can already be scheduled in most states, though you might want to call your specific office to be sure they’re taking elective appointments. With the reopening of many states, the AOA has no qualms about scheduling elective appointments if you can. “Whether you have eye health or urgent care needs, concerns about your eyes or vision—such as digital eye strain or dry eyes—or it's time for a comprehensive eye exam or contact lens evaluation, patients are encouraged to schedule appointments with their local doctor of optometry for their essential primary eye care needs,” Dr. Horn says. The AAO also says that, depending on state reopenings, elective procedures and checkups will also be available depending in location and practice.

In states that aren’t yet open for elective procedures, it’s still important to make a trip for emergencies. While it’s not always immediately clear whether something is urgent—splashing a chemical in your eye would likely feel like an emergency, but seeing black spots might not—a good rule of thumb is to call your doctor to find out. “If you wake up one morning and you're not seeing well out of one or both eyes, then you should at least call your physician and find out what their advice would be on when to be seen,” Dr. Lema says. Like many other health care professionals, lots of eye doctors are offering telehealth appointments, so you can check in about symptoms like greying vision or floaters, and find out if it really is essential to go in.

And if your doctor does tell you it’s an emergency, make the appointment. Although it can feel scary to step outside your home for any reason, it’s important not to neglect your eye health, or any other type of health, in an effort to remain as socially distant as possible.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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