Optometrists are now open for routine care. Below are the guidelines all optometrists in Manitoba are following during the COVID-19 pandemic. Some clinics may still only be open on a limited basis. If you have any questions, contact your optometrist's office or the Manitoba Association of Optometrists, 204-943-9811. The MAO office is staffed but is closed to the public, we will respond to calls and emails. 

For up-to-date information regarding COVID-19, visit manitoba.ca/covid19

 

Council Policy Statement
Practice During the COVID-19 Pandemic


1. Introduction

The Manitoba Association of Optometrists, as the regulatory body for optometry, issued a Return to Work Policy (effective May 4, 2020/amended June 8, 2020) with respect to the practice of optometry during the pandemic. Effective August 27, 2020, the Council Policy Practice During the COVID-19 Pandemic was issued, replacing the Return to Work Policy.

Effective November 20, 2020, the Manitoba Association of Optometrists adopts the following as a Policy of the Association: The Council Policy Practice During the COVID-19 Pandemic dated August 27, 2020 is hereby replaced. This Policy may be amended from time to time – the current version of this Policy will be found on the MAO website.

Government and the Provincial Public Health Office, together with health regulatory bodies, hold the formal authority to set the parameters of patient care. Processes and recommended policies during a pandemic may change. Guidelines are subject to change as information evolves. Public Health Orders may be imposed and amended. Members must be vigilant in staying current with health-related updates and government orders.

  

2. Practice Requirements

Each member must create/maintain safe and effective office policies with respect to the practise of optometry and dispensing of eyewear. Policies should include precautionary screening, patient and staff management, physical distancing, training on the proper use of PPE, and implementation of proper infection control protocols.

Every effort must be made to maintain appropriate physical distancing of 2 m (≈ 6 ft) between everyone in the clinic (optometrists, staff, and patients).

Optometrists and staff must wear appropriate PPE while in the clinic, with the following exceptions:

  • In private areas of the clinic (staff rooms and offices) when consuming food or drink.

Patients must wear masks while in the clinic, with the following exceptions:

  • Children under the age of five;
  • Individuals with medical conditions unrelated to COVID-19, including breathing or cognitive difficulties, or a disability, that prevents them from safely wearing a mask; and
  • Any person unable to put on or remove a mask without the assistance of another person.

Patients must provide written confirmation from a medical practitioner that they have such a condition, difficulty or disability, or inability to put on or remove a mask without assistance of another person.

Masks must cover the nose, mouth and chin. Valved masks are not acceptable.

Adhering to disinfection and infection control procedures is mandatory.

  
A. Precautionary Screening:

i. Signage indicating screening criteria must be placed in a location that is visible before entering the building.

ii. Patient flow into the clinic should be controlled (consider locking doors, having staff control entry/exit to limit capacity and control exterior spacing line ups, or having patients wait in their vehicles for a phone call).

iii. Prior to entering the clinic, all optometrists, staff, and patients should be screened and self-declare the status of their health. Optometrists, staff, and patients must be asked

  • whether they have symptoms consistent with COVID-19, have been in contact with a known COVID-19 case (see COVID-19 Screening Tool at https://sharedhealthmb.ca/covid19/screening-tool/); and/or
  • whether they have travelled outside of Manitoba, Western Canada, the Territories or Ontario west of Terrace Bay (or as identified in current Manitoba Public Health Orders) in the last 14 days. Optometrists should continue to visit the Shared Health website for the most up to date screening criteria.

iv. Optometrists may see patients who are essential workers who have travelled outside of Manitoba, the Territories or Ontario west of Terrace Bay (or as identified in current Manitoba Public Health Orders) in the last 14 days, provided that these patients pass all other screening criteria.

v. Optometrists should not see any patients in the clinic who do not pass the screening criteria. Any patient who does not pass screening criteria and has an urgent/emergent eye issue that cannot wait should be directed to the Misericordia Health Centre. There may be separate accommodations made for remote practice settings; in these cases, optometrists should call the on-call ophthalmologist for further guidance.

vi. Optometrists, staff, and patients who do not pass the screening should be directed to return home and follow appropriate self-isolation/quarantine processes and complete the Shared Health Screening Tool.

vii. Any optometrists, staff, and patients identified as being symptomatic should be instructed to call Health Links-Info Santé for further instruction.

viii. Contact information must be recorded and retained for all individuals entering the clinic, including those who attend the clinic without an appointment or individuals who accompany an individual with an appointment.

  
B. PPE Required:

i. Masks (surgical, KN95, or N95) must be worn. One mask may be used for an entire work shift (see Shared Health website resources on proper storage/removal techniques). Valved masks are not acceptable.

ii. Eye protection (goggles, full coverage safety glasses, or face shield) is recommended for optometrists and staff, but optometrists may use professional judgment in implementation of this recommendation.

iii. Hand Hygiene. Hands must be washed or sanitized immediately before and after any patient encounter. Single use latex or nitrile gloves may be used, once only, in a single patient encounter.

iv. Optometrists and staff must be educated on proper techniques for donning and doffing PPE.

v. Gowns are not required.

  
C. Clinic Environment:

i. Staff/optometrists

     a. Staff/optometrists must wash or sanitize hands immediately upon entry to the clinic.

     b. Maintain appropriate space of 2 m between staff/optometrists and patients when/where possible.

     c. It is recommended that floors be marked to ensure appropriate spacing in public areas and staff workstations.

     d. It is recommended that plexiglass/acrylic partitions be added to reception and dispensary desks.

     e. Regularly disinfect common touch points in the clinic (examples - doorknobs, counters, keyboards, phones, POS, pens, washrooms, faucets, etc.).

     f. Avoid sharing workstations wherever possible.

     g. Stagger break times to limit overcrowding in staff rooms.

     h. Consider staffing in “teams” to minimize interaction between staff members.

     i. Staff/optometrists should wear attire that can easily be washed and/or removed if contamination occurs (some may prefer scrubs for ease of use).

     j. Avoid wearing jewelry, scarves, or other loose-fitting items and consider tying up long hair.

     k. It is recommended that staff/optometrists change their clothes before entering the main living space of their homes and wash their work clothes immediately.

ii. Patients

     a. Patient volumes must be managed to maintain appropriate physical distancing and minimize in-office wait times.

     b. Patients must wash or sanitize hands immediately upon entry to the clinic.

     c. Patients should be instructed to wear a mask or cloth face covering from the time they enter until the time they leave the building. The optometrist has the right to make this a requirement, and determine suitability of the face covering, in order to see the patient.

     d. Arrange seating in patient areas to provide a minimum of 2 m between chairs.

     e. Remove magazines, toys and other peripheral items from waiting areas and exam rooms.

     f. Ask patients to leave unnecessary items in their car or outside.

     g. Ask patients to come in alone unless another person is necessary (parent of child, mobility aide, translator).

     h. In order to minimize the amount of time patients spend in the clinic, optometrists and staff should try to update as much information as possible prior to the appointment (e.g. MB Health card information, address/phone # changes, patient ocular and medical history).

  
D. Physical Examination of the Eyes:

i. The slit-lamp should be equipped with a large plexiglass/acrylic shield.

ii. The examiner must wear a mask (surgical, KN95 or N95). The mask must be worn from before the time the patient enters the exam room until after they leave. Eye protection (goggles, full coverage safety glasses or face shield) is recommended for optometrists and staff, but optometrists may use professional judgment in implementation of this recommendation.

iii. Hands must be washed or sanitized immediately before and after any patient encounter. Single use latex or nitrile gloves may be used, once only, in a single patient encounter.

iv. Cotton tip applicators should be used to manipulate the eyelids.

v. Examinations should be performed expeditiously, with minimum talking during the examination.

vi. Following every examination, all surfaces that the patient touched, or exposed to respired droplets from the patient should be disinfected with wipes capable of killing the virus. Such areas typically include equipment that touches the patient’s face, handles or other parts of equipment touched by the patient, and any parts of the examining chair touched by the patient. All devices (tonometer tips, cotton swabs, etc.) that contact the patient should be disposed of or disinfected.

   
E. Considerations for Specific Procedures:

i. During procedures that require close face-to-face distancing, the patient should be instructed not to speak, and the staff/optometrist should make every attempt to provide verbal instruction prior to beginning the procedure.

ii. Pretesting/auxiliary testing

     a. Optometrists and staff must wear/use appropriate PPE (mask, hand hygiene) throughout all patient encounters. Eye protection is recommended for optometrists and staff, but optometrists may use professional judgment in implementation of this recommendation.

     b. Optometrists should use their best clinical judgment and evolving clinical evidence when deciding when to measure IOP and the method of IOP measurement.

     c. Some (but not all) manufacturers have provided instructions for sanitization/disinfection of visual field machines. Unless the full threshold visual field machine (i.e.: Zeiss/Humphrey/ Octopus/Medmont) can be sanitized/disinfected, full threshold visual fields may be conducted for emergency cases only. In all cases where a full threshold visual field test is performed, whether routine or emergency, patients must wear a mask and the staff member or optometrist must wear appropriate PPE (mask, hand hygiene) and limit the amount of time spent near the patient as much as possible. Eye protection is recommended for optometrists and staff, but optometrists may use professional judgment in implementation of this recommendation.

iii. Glasses dispensing

     a. New glasses may be fitted, observing proper use of PPE (mask, hand hygiene) during the encounter. Eye protection is recommended for optometrists and staff, but optometrists may use professional judgment in implementation of this recommendation.

     b. Frames must be cleaned and sanitized immediately after contact by each patient, before being placed back on display.

     c. Efficiency in frame and lens selection is strongly encouraged to minimize the length of time of the encounter.

     d. Adjustments and repairs may be made to a patient’s personal frames. Frame adjustments requiring close contact with the patient require the use of PPE (masks, hand hygiene). Eye protection is recommended for optometrists and staff, but optometrists may use professional judgment in implementation of this recommendation.

          -Frames should be sanitized prior to making the adjustment/repair and tools must be sanitized after use (hands must be washed/sanitized, or gloves donned/doffed immediately before and after handling the patient’s glasses).

     e. Consider mounting plastic shields on pupilometers and using a ruler or other automated measuring device to maintain extra distance whenever possible.

     f. Booking of appointments for dispensing glasses and repairs is recommended.

iv. Contact lens training
Contact lens trainings should be conducted in a way that minimizes risk to the patient and the trainer. The training should be conducted in a touch-free fashion. Patients should handle their own contact lenses; the trainer should use their own disposable contact lens to demonstrate insertion/removal and care techniques. It is recommended that videos be used to minimize the amount of time spent in close proximity, and recommended that plexiglass/acrylic barriers be used between the patient and the trainer. The trainer must observe proper use of PPE (mask, hand hygiene). Eye protection is recommended for optometrists and staff, but optometrists may use professional judgment in implementation of this recommendation.

v. Personal Care Home/Assisted Living/Home Visits
At this time, personal care home/assisted living/home visits are not permitted.

  
F. Disinfection/Sanitization for Optometry Specific Devices:

Optometrists should follow manufacturers’ recommendations for disinfection/sanitization of specific instruments/equipment.

i. Tonometry
Applanation probes must be disinfected by soaking in 3% hydrogen peroxide for 10 minutes.

ii. Glasses frames
Glasses frames must be disinfected/sanitized after contact with a patient. Options for sanitizing/disinfecting include cleaning with warm soapy water (the lipid bilayer that coats the coronavirus is susceptible to surfactants), or other alternatives such as UV light or other disinfectants. Care should be taken in choice of sanitizing/disinfecting process due to the possibility of damage to frames/finishes.

iii. Gonio lens
Must be washed in soap and water and the ocular contact zone must be soaked in 3% hydrogen peroxide for 10 minutes.

  
G. Virtual Care:

Optometrists are encouraged to continue providing virtual care (telephone/video consultations) wherever possible to minimize the number of in-person visits, especially for more vulnerable patients.

  


Resources:

July 24, 2020 Order of the Chief Provincial Public Health Officer under the Public Health Act https://www.gov.mb.ca/asset_library/en/proactive/2020_2021/orders_soe_07242020.pdf

COVID-19 Information https://manitoba.ca/covid19/index.html

Shared Health
COVID 19 Screening Tool
https://sharedhealthmb.ca/covid19/screening-tool/

Shared Health – COVID-19
Guidance on the Removal, Storage and Extended Wear of Face Masks
https://sharedhealthmb.ca/files/extended-use-of-face-masks.pdf

Shared Health
PPE Provincial Requirements – Outpatient Settings/Community Clinics
https://sharedhealthmb.ca/files/ppe-provincial-requirements-outpatient-settings.pdf

Shared Health
PPE Provincial Requirements – Administrative and Reception All Settings
https://sharedhealthmb.ca/files/ppe-provincial-requirements-admin-reception.pdf

Shared Health
PPE Provincial Requirements – Patients
https://sharedhealthmb.ca/files/ppe-provincial-requirements-patients.pdf

Shared Health
COVID-19 – Provincial Infection Protection & Control Advice on Use of Personal Protective Equipment, Scrubs, Uniforms and Footwear
https://sharedhealthmb.ca/files/covid-19-provincial-infection-prevention-control-advice-ppe.pdf

Canadian Centre for Occupational Health and Safety – Emergency and Patient Intake (link from Shared Health): https://www.ccohs.ca//images/products/pandemiccovid19/pdf/emergency_patient_intake.pdf

Donning and doffing PPE:

Provincial COVID-19 resources for health-care providers and staff (Shared Health) https://sharedhealthmb.ca/covid19/providers/

Resources for Providers and Clinics – Primary Care (Shared Health) https://sharedhealthmb.ca/covid19/providers/resources-for-providers-and-clinics/

Current State of Emergency and Public Health Orders https://Manitoba.ca/covid19/protection/soe.html

  
APPROVED: November 20, 2020