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“Due to the coronavirus, [optometrists] are only allowed to see a certain number of patients per day and have a certain number of people that are allowed to be in the lobby. There’s all this screening that has to be done and extra sterilization. And so, there’s a backlog of people who have been impacted. Optometrists are up against the wall with new regulations that are slowing their business.”
Geoff Knapp, Executive Director of the Oregon Optometric Physicians Association (OOPA)
The spread of Covid-19 has raised concerns about the disease’s long-term effects on our health, specifically on our lungs, hearts, and brains. The type of pneumonia often associated with Covid-19 can create scar tissue in the lungs and lead to long-term breathing problems. Imaging tests have also shown lasting damage to the heart muscle, even in people who experienced only mild symptoms. And there’s also the increased risk of strokes, seizures, Guillain-Barre syndrome, Parkinson’s disease, and Alzheimer’s disease.
But did you know that the pandemic also poses risks to the health of your eyes?
Yes, it’s true—but perhaps not in the way you might think. Missed appointments with optometrists, face masks’ negative effect on our eyes, and perhaps most of all, dramatically increased screen time, all add up to wreaking havoc on your eye health.
According to the American Optometric Association, the prolonged viewing of a computer screen makes the eyes work harder, creating susceptibility to the development of vision-related problems. “Factors, such as screen or font size, glare, definition, luminosity and contrast, viewing distance or angle, all can increase discomfort and exacerbate uncorrected vision problems,” the AOA wrote.
Unfortunately, access to eye care has also taken a hit due to the pandemic. With the introduction of stay-at-home orders, eye exams have become a lower priority for many, despite increased risks to eye health. In addition, increased safety protocol requirements mean that doctors are able to see fewer patients, creating a backlog.
For National Save Your Vision Month in March, we spoke to two movers and shakers in the world of optometry to learn about the importance of comprehensive eye exams and the internal battle that the optometry community is waging in Oregon.
Meet the Experts: Dr. Fraser Horn and Geoff Knapp
Geoff Knapp is the executive director of the Oregon Optometric Physicians Association (OOPA). He serves as the key corporate officer responsible for implementing the vision of the board of directors through strategic planning. Prior to entering his current role in January of 2020, he served as the reputation manager for ReputationUs, a public relations firm in Portland, Oregon. His background in crisis communications has served him well since he took on the leadership role at the OOPA and has had to tackle various complications due to the coronavirus. Knapp has his bachelor of science in public relations and journalism from Utica College of Syracuse University.
Dr. Fraser Horn is the dean of Pacific University’s College of Optometry—one of the highest rated optometry programs in the Pacific Northwest. He provides lectures in the Sports and Recreational Vision, Ocular Disease I, Applied Ocular Therapeutics and Ocular Emergencies courses. He was elected as Chair of the AOA Sports Vision Section Council in June 2014.
The Importance of Comprehensive Eye Exams
Many of us neglect our eye health because of the belief that our eyes don’t need much maintenance, but visual system diseases can develop without any obvious signs or symptoms, which, without comprehensive eye exams, can go undetected for years.
In the U.S., the prevalence of blindness and visual impairment is projected to double by 2050 due to a lack of access to care. “The millions who will confront vision loss in the coming years may experience losses in quality of life, financial decline, and social isolation,” the 2016 study writes.
“Glaucoma is the silent stealer of sight. Cataracts also slowly reduce your vision, and those are both very common throughout the world,” Dr. Horn said. “Definitely, a lack of access to care has become an issue with glaucoma, cataracts, diabetic eye disease, and so really that becomes a big consideration. We’re looking at not just problems with the eye, but also systemic issues that we can see in the eye.”
Eye exams enable doctors to detect more than 270 serious health conditions including diabetes, high blood pressure, autoimmune diseases, and cancers. That’s why experts recommend patients make appointments for in-person eye exams once a year.
“Eye screening, which is your traditional eye chart on the wall, will identify immediate problems with vision, but it’s different from the comprehensive eye exam,” Knapp explained.
Unlike screenings, comprehensive exams assess both your visual system and eye health, involving a number of different tests in order to provide a complete evaluation of the health of your eyes and your vision.
The Effects of Screen Time on Our Eyes
In our increasingly digital world, these exams are even more important for both children and adults. In April, Gallup reported 83 percent of American school-age children were learning remotely through school-sponsored online distance education. Now, children aged 6-12 are in front of a screen twice as much as they were before the pandemic, increasing their risk of developing eye-related problems.
“There are studies that have been done that say that youth who go through their school years with eye problems will face major problems later on in adulthood that will put them in a category of crime, misbehavior, and underachievement in school, so it is highly critical at that very young age to start the exams,” Knapp said.
Adults are also at an increased risk. Sixty-three percent of U.S. employees reported working from home as of early May 2020, a 31 percent increase since mid-March. While many employees are used to spending hours in front of a computer, home workspaces may be less than ideal for eye health, on top of the increase in Zoom and Skype meetings instead of regular office meetings.
“When you read a book, you have black letters on a white page and it’s a really sharp contrast, so your focusing system gets really good feedback. But when you’re looking at a screen, you don’t get that same contrast,” Dr. Horn explained.
“If you think back to caveman, cavewoman times, we were made to look out at distances for any problems, so when you sit there and look at a screen for hours on end, your focusing system is working overtime,” he continued. “What ends up happening is you start to feel strain or pressure right above your eyes, and that’s just really because your focusing system is working overtime.”
Screen time contributes to loss of focus flexibility, impacting the ability to adjust your eyes to see at all distances quickly. This typically happens as we age, but is accelerated by increased screen time. It can also cause early-onset nearsightedness, especially for children, whose eyes are still developing. In addition, the blue light from screens can also damage the inner lining of the back of your eye. This can lead to early age-related macular degeneration, which can lead to loss of eyesight.
While these increased risks should mean that Americans should be heading to their optometrists in greater numbers, stay-at-home orders have discouraged individuals from scheduling appointments with their optometrists. Additionally, new safety regulations have caused a bottleneck at many optometry clinics.
“Due to the coronavirus, [optometrists] are only allowed to see a certain number of patients per day and have a certain number of people that are allowed to be in the lobby. There’s all this screening that has to be done and extra sterilization,” Knapp explained. “And so, there’s a backlog of people who have been impacted. Optometrists are up against the wall with new regulations that are slowing their business.”
If you have access to optometric care and are concerned about your eye health during the pandemic, Dr. Horn and Knapp both recommend making an appointment with a professional.
Legislative Changes Afoot: Expanding the Practice Authority of Optometrists
Amidst challenges presented by the pandemic, the optometry community is also engaged in an effort to increase their scope of practice so that they are able to offer patients more services.
Currently, in most states, ophthalmologists are responsible for performing laser surgeries. But states like Alaska and Oklahoma have already won a wider scope of practice for optometrists on their own turf, and as many as 28 states are trying to accomplish similar goals.
“We [the OOPA] are putting forth legislation this year in the state of Oregon to allow our docs through a change of statute to extend the scope of practice to include laser surgery for things like glaucoma treatment and some other surgeries that are very simplistic,” Knapp explained. “It will reduce the number of times that a person who has had cataract surgery will have to go for follow-ups to ophthalmologists in areas that are way outside of their region. Those specialists can be hard to make appointments with.”
In rural communities, there may not be an ophthalmologist based anywhere nearby, meaning that patients have to arrange special trips to urban areas in order to get the care that they need. If optometrists were given the freedom to provide these services, this problem would be eliminated.
But the optometry community has had a hard time moving forward with this new expanded scope of practice, in part, because ophthalmologists are providing resistance to the statute changes.
“It’s more aligned with precedence than it is anything else because they’ll argue that optometrists don’t have the education or training to match their own, which is a falsehood,” Knapp said.
Pacific University’s optometry program, of which Dr. Horn is the dean, is one example of a program that offers courses beyond the current scope of practice in the state, meaning students may be tempted to move out of state in order to utilize their entire skill sets.
“When you are trained to do the full scope and then you’re limited by legislation, it’s frustrating because you know what you can do to provide for your patients,” Dr. Horn said. “And it’s tough when you have those skills and the ability to do it, but you have to refer out to do things.”
“This is not a money-making venture for our doctors, it is more of a patient service, and making sure that they’re getting the best care that they can,” Knapp added.
Dr. Horn went through his own experience of being limited by regulations in Maryland when he was doing his residency.
“When I worked at a private practice, I couldn’t do basic things and it was so frustrating, not because it was a personal thing for me, but because now the patient had to take more time, go get another appointment, maybe miss work when I could have just done it for them right then and there.”
In 2019, the American Academy of Ophthalmology (AAO) responded with a fundraising appeal to its members to combat the “scope grab” by the optometry community to perform “above the limits of their training” and sought contributions to a special fund established to lobby against state law updates.
But the U.S. department of health and human services (HHS) has taken the side of optometry on the issue, stating that “states should consider changes to their scope of practice statutes to allow all health care providers to practice to the top of their license, utilizing their full skill set.”
“It will be about infringing a little bit on other profession scopes and it will be about training,” Dr. Horn added. “There will be challenges because individuals and individual professions will see another profession’s expansion as a threat. The way I look at it is that we are trying to do something that provides care for our patients in conjunction with our partners in ophthalmology, and this actually can help certain practices where there are ophthalmology and optometry that work together. It helps those practices and it helps those patients. I think the push-back is really going to come back to whether optometrists are properly trained or not.”
Nina Chamlou is an avid writer and multimedia content creator from Portland, OR. She writes about aviation, travel, business, technology, healthcare, and education. You can find her floating around the Pacific Northwest in diners and coffee shops, studying the locale from behind her MacBook.