COVID-19 Return to Work

Return to Work: Infection Prevention and Control for Optometric Practice presents guidance for optometrists preparing for the eventual return to work during the ongoing COVID-19 pandemic. The contents of this guidance will be reviewed and updated as Ontario progresses through each phase of its recovery, and as new guidance or recommendations are made by the provincial government.

Directive #2, which previously limited the provision of non-urgent care, was revised on May 26, 2020.

Optometry practices must comply with both the College’s Return to Work guidance and the Ministry of Health guidance COVID-19 Operational Requirements: Health Sector Restart, prior to opening.

Return to Work Frequently Asked Questions

Can we see patients who live in other provinces?
Yes. The Ministry of Health Patient Screening document no longer lists travel outside of Ontario as a positive screening result (though travel outside of Canada remains so).

Can optometrists and staff work if they travel between provinces?
Health care workers and staff can continue to work, but should self-monitor for symptoms and ensure they are screening patients and wearing appropriate personal protective equipment (PPE). Anyone who develops symptoms should self-isolate and contact Telehealth Ontario or their primary care provider.

Can we see patients who travel from outside of Canada?
Travel outside of Canada within 14 days remains a positive screening result for COVID. For these individuals, the first considerations should be

  1. can the appointment be deferred,
  2. can care be provided using telehealth, or
  3. is there a 14-day window when the patient will not be traveling that may allow for scheduling and a negative screening result.

If none of the above options are feasible, then optometrists should consider

  1. scheduling the patient in-person and with use of additional PPE (prescribed by the Ministry’s Operational Requirements: Health Sector Restart p. 12), i.e., isolation gown and gloves, in addition to surgical/procedure mask and eye protection, or
  2. referral to an ophthalmologist or optometrist with the above PPE.

Where should I purchase personal protective equipment (PPE) and what brands are recommended?
The College is not in a position to recommend or approve certain types/brands or PPE suppliers. Public Health Ontario has resources related to infection control practices that may be helpful to optometrists. Mouth, nose, and eyes must be covered by PPE. Prescription glasses are not acceptable as eye protection unless they are equipped with side shields.

The provincial government has developed a PPE supplier directory.  In addition, the Ontario Association of Optometrists (OAO) is working to provide optometrists with information on accessing PPE.

Optometric colleagues, interprofessional colleagues, and the OAO may be able to answer specific questions or provide recommendations as to PPE currently in use.

What is the appropriate way to don/doff PPE?
Public Health Ontario has numerous resources (both in print and video) on proper technique for donning and doffing PPE:

What is considered suitable eye protection?
The College is not in a position to recommend certain brands of PPE. Eye protection should cover both the front and sides of the face and includes safety glasses, safety goggles, face shields and visors attached to masks. Prescription glasses are not acceptable as eye protection.

If a patient arrives to an appointment without a mask, do I cancel the appointment?
If a patient arrives without a mask, optometrists should provide patients with a mask to wear. If the optometrist is unable to provide a mask, the appointment should be rescheduled or cancelled, or provided using telehealth if possible.

If a patient doesn’t bring their own mask, can I charge them for a mask I provide?
Providing equipment and supplies needed to control the spread of infection (such as personal protective equipment/masks) is a part of OHIP-insured services. Optometrists cannot charge OHIP-insured patients for these services as that would be considered extra-billing.

Any fees charged to patients who are not OHIP-insured must be reasonable and not excessive. Optometrists must consider the patient’s circumstances and access to care when determining fees. Patients should be informed of any fees in advance of an appointment.

What if a patient cannot wear a mask?
Providing optometry care does not allow for physical distancing. The College guidance and recommendations were developed after careful review of infection prevention and control information from public health, specific recommendations related to COVID-19, and best practices for optometry.

Optometrists should use their professional judgement in individual circumstances and determine if they are able to safely provide care if the patient does not wear a mask. Optometrist must determine what is needed to keep themselves, staff, and other patients safest. Depending on the nature of the appointment, you may be able to provide care in person, virtually, or recommend deferring the appointment to a later date if not urgent.

What if a patient insists that it is their human right to receive a service without wearing a mask?
The Ontario Human Rights Commission (OHRC) has an FAQ that outlines human rights concerns related to COVID-19.

This FAQ notes that:

  • …any requirements related to health and safety and COVID-19, such as wearing a mask…do not generally cause concern under the Code.
  • …service providers should recognize that health and safety requirements such as masks may have a negative impact on vulnerable populations identified by a ground under the Code who may not have access to such equipment… and
  • …the Ministry of Health advises that face coverings should not be placed on or used by children under the age of two, anyone who has trouble breathing, or anyone who is unable to remove it without assistance.

Read the full FAQ on the OHRC website.

What if an optometrist or staff becomes ill with COVID-like symptoms?
Optometrists and their staff must not present to work when ill with symptoms of infection. Any person with symptoms of COVID-19 should stay home, contact their primary care provider or Telehealth Ontario, and should not return to work until they are asymptomatic and have been cleared by their primary care provider or Telehealth Ontario of any concern of COVID-19.Any confirmed case of COVID-19 in an optometrist, staff, or visitor to the office should be reported to the local public health unit. Optometrists should follow the subsequent directions of their local public health unit.

Optometrists are now able to resume new contact lens fittings. What are the best ways to manage this while ensuring physical distancing from patients and suitable infection prevention practices?
The College has revised it’s guidance so that new contact lens fittings are no longer prohibited, however, we recognize these fittings pose some challenges re: physical distancing and uncertain duration. When providing contact lens fittings, optometrists could consider measures that would limit the time in close contact with patients, including:

  • Providing some of the contact lens training via telehealth (i.e., video instruction)
  • Using complementary instruction videos before (e.g., insertion and removal techniques) and/or after (e.g., cleaning lenses) the training
  • Using barriers (such as Plexiglas) within the office setting to separate optometrists/staff from patients learning insertion/removal
  • Using gloves and other PPE that may add additional protection and align with patient expectations (see: guidance from the British Contact Lens Association)

Optometrists should use their professional judgement re: readiness to provide new contact lens fittings. If an optometrists is unable to provide fittings, they should inform patients when these appointments may resume and provide patients with options for alternative care, such as referral to another optometrist.

Can I use a combination of fundus photography and imaging technology (e.g., OCT) for all patients as the only method of examining the fundus, or as a substitute for dilated fundus examination?
No. The standards of practice regarding pharmacologic dilation are unchanged and may be reviewed under OPR 6.2. Please also refer to the College’s Policy on Digital Imaging/Fundus Photography in Optometric Practice.

Is it OK to use 3% hydrogen peroxide to clean Goldmann tonometer prisms? Is it OK to clean eyeglass frames using soap and warm water? These are not included among the examples cited under high- and low-level disinfectants in the College’s guidance (Control of the Environment).
Generally speaking, the answer to these questions is yes. The referenced examples are cited from a source document, and many of the examples of high-level disinfectants will only be appropriate for hard surfaces and will damage clinical equipment (e.g., tonometer probes). Optometrists should refer to manufacturer and best-practice professional guidelines, and use their clinical judgment regarding choice of disinfectant agent.  Optometrists should avoid disinfectants (and/or contact times) that will damage clinical equipment or eyeglass frames (of various materials).

Questions relating to practice management (e.g., billing) should be directed to the Ontario Association of Optometrists.