San Francisco’s Pacific Vision Institute Sees Surge in Patients

I recently had the pleasure of interviewing Dr. Ella Faktorovich, founder of San Francisco’s Pacific Vision Institute, about a surge the doctor is seeing in patients seeking relief from wearing glasses and/or contact lenses. During our conversation, we talked about new safety procedures the Institute has put in place for her staff and patients, trends she’s seeing in the types of patients coming in the door and the effect video learning can have on children’s eyes.

Pacific Vision Institute is at the forefront of advanced vision correction. The clinic is equipped with the latest generation of state-of-the-art diagnostic and vision correction technology to address a range of vision problems and eye conditions. Dr. Faktorovich is among the leading ophthalmologists practicing in California. As an innovator in the development of advanced vision correction treatments, she has achieved worldwide acclaim for her contributions in the field of refractive surgery.

Rick: What is the typical vision correction candidate coming to your office today look like?

Dr. Faktorovich: We’re seeing an increase of people wanting good eyesight if/when another emergency arrives. They don’t wish to use contacts for the fear of touching their eyes, and they’re concerned about their glasses fogging up while wearing a mask and worried about continually adjusting said mask. I’m seeing people who are doing more outdoor activities (cycling, running, etc.) that result in sweating (especially with warmer weather now), which forces glasses to slide on the nose. And with the increase of people working remotely, the time they spend online has increased, which causes eye strain and difficulty wearing contacts. And finally, because new work from home schedules are more flexible, it’s allowing individuals to schedule time for vision correction and recovery, a luxury they didn’t have historically.

Rick: With COVID-19 still in the headlines, some potential patients may be hesitant to come to your practice. What measures have you put in place to protect your staff and patients?

Dr. Faktorovich: As a surgical facility, we’ve always been exceedingly careful about maintaining a clean environment. This includes the air filtration system and extensive precautions to protect patients against pathogens. But, with COVID-19, we’re taking extra precautions. For example, our staff was instructed to watch videos on how to use hand sanitizer, how to wash hands and how to put on a mask properly.

Everyone who works at the clinic is instructed to keep a set of clothing and footwear in the clinic, to be worn only in the clinic. They are to change into it when they arrive and change out of it before they depart. Clothing and footwear that’s worn outside is placed in paper bags in designated areas away from patient areas. Staff with long hair have been instructed to keep the hair neat, in a bun. No outside food or drink is allowed in the clinic.

Preferred masks for staff are the ones with elastic bands that go behind the ears. These are the easiest to put on and remove without touching the face.

Before examining each patient, the doctors sanitize their hands with a combination of chlorhexadine/alcohol sanitizer - this is what typically is used in operating rooms. A recent review in Frontiers of Public Health recommends using chlorhexadine/alcoholic hand rub rather than alcohol alone. Chlorhexadine actually binds to skin cells and stays on hands for a long time.

All deliveries are left outside clinic door and are disinfected prior to bringing them in, and all patients are e-mailed questions about their health and exposure risk before their appointment.

Rick: I read a story recently that suggested COVID-19 can be transmitted through the eyes.

Dr. Faktorovich: In my summary of the research done to date, I believe questions about ocular symptoms should be added to the list of questions medical clinics are currently asking patients around systemic symptoms they may be experiencing before they enter a medical clinic. The ocular questions should include specific references to eye redness, tearing, discomfort, foreign body sensation and discharge. Clinicians have to decide if their clinic can care for patients with a high probability of shedding the virus or whether they should be triaged to a center fully prepared to safely manage such patients.

If patients have conjunctivitis, clinicians should have high suspicion that they will be shedding virus from their ocular secretions and are, therefore, contagious. In this case, more than hand sanitizer and mask is needed. Clinicians should wear gloves when examining such patients and then immediately discard the gloves using the same precautions as when discarding highly contagious waste material. Clinicians should also assume that symptomatic patients have virus in their nasopharyngeal secretions and that the virus likely will be aerosolized when they speak. Therefore, wearing an N95 mask and tight-fitting goggles is essential. Patients should be instructed to not speak when the examiner is in close proximity to them.

On the other hand, if patients have neither systemic nor ocular signs and/or symptoms suggestive of COVID-19, the probability of them harboring the virus on their ocular surface is very low. When examining such patients, good hand hygiene and face mask are still important for both the patient and the examiner, but goggles and respirator masks may not be necessary. A recent review in Frontiers of Public Health recommends using chlorhexadine/alcoholic hand rub rather than alcohol alone.

Rick: Are children who are doing online learning in trouble for developing poor eyesight because they’re staring into their displays for longer periods of time?

Dr. Faktorovich: When I see parents who have come in for laser vision correction, they often ask me about their children’s screen time and whether or not too much exposure can be harmful to their eyes. According to the Vision Council more than 70 percent of American adults report their child(ren) receive more than two hours of screen time per day, yet nearly 25 percent are still not concerned about the impact of digital devices on their child(ren)'s developing eyes.

Eye fatigue, also called digital eye strain, is a physical eye discomfort that is caused by excessive screen use, and it is a common condition in both children and adults. To prevent children from developing vision issues, such as myopia, which can stem from excessive eye fatigue, it’s important for parents and teachers to be able to spot if a particular student is in discomfort and immediately implement ways to alleviate it.

A few warning signs to be on the lookout for: Leaning into, squinting and staring into LED screens are common behaviors that cause eye fatigue and come with many warning signs including:

• Eye irritation
• Watery eyes
• Headaches
• Intermittent blurry vision or double vision
• Sore eyes
• Difficulty concentrating
• Sore neck, shoulders and/or back.
• Increased sensitivity to light
• Tiredness
• Poor posture

To reduce kids' computer eye fatigue, parents/teachers should, at minimum, ensure the students are engaged in outdoor activities between 8-15 hours per week. Screens should be at least 20 centimeters away from a student’s eyes. Parents should place their child’s reading/study desk near a window, and have them look outside every hour. And children should be kept in fully corrected glasses, not under corrected. And those glasses need to be worn full time.

Rick: Thank you for your time, Dr. Faktorovich, very wise advice indeed.