Dr Daniel Laroche Discusses Eye-Related Implications, Barriers to Eye Care Amid COVID-19

August 1, 2020

Whether you fit into the older or younger demographic, staying up to date on eye care is key as growing risks of cataracts, glaucoma, diabetic retinopathy, and macular degeneration are leading causes of blindness. Moreover, reducing the structural barriers to eye care, which disproportionately affect blacks and Afro Latinos, can assist in advancing the availability of eye health nationwide, said Daniel Laroche, MD, director of Glaucoma Services and president of Advanced Eye Care of New York.

Whether you fit into the older or younger demographic, staying up to date on eye care is key as growing risks of cataracts, glaucoma, diabetic retinopathy, and macular degeneration are leading causes of blindness. Moreover, reducing the structural barriers to eye care, which disproportionately affect blacks and Afro Latinos, can assist in advancing the availability of eye health nationwide, said Daniel Laroche, MD, director of Glaucoma Services and president of Advanced Eye Care of New York.

AJMC®: Hello, I'm Matthew Gavidia. Today on the MJH Life Sciences’ Medical World News, The American Journal of Managed Care® is pleased to welcome Dr Daniel Laroche, a glaucoma specialist in New York. He also serves as director of Glaucoma Services and president of Advanced Eye Care of New York. Can you just introduce yourself and tell us a little bit about your work?

Laroche: Yes, my name is Dr. Daniel Laroche. I'm an ophthalmologist having been practicing for the last 25 years in New York City. I’m affiliated with the New York Eye and Ear Infirmary, NYU, in private practice with offices in Harlem and Southeast Queens, and a clinical assistant professor of ophthalmology at New York Eye and Ear of Mount Sinai.

AJMC®: Are there any eye-related implications of COVID-19? In previous research it was noted that the virus may cause conjunctivitis–are these concerns still relevant or have they been added upon in the ophthalmology field?

Laroche: Yes, with patients that are inpatients at the hospital with COVID-19–about 30% can get conjunctivitis associated with that. Also, there's been reports anecdotally of conjunctivitis, of being the initial symptom of COVID-19. The majority of cases are spread via the nose, mouth coughing, touching with the hands. It's very important to hand wash, very important to wear a mask. At the hospital, as a surgeon, or at the hospital, we are asked to wear eye protection, and I think it's not unreasonable for those at higher risk–people over the age of 70, people with immunocompromised states that have to go out for them to wear eye protection as well to really reduce the risk of spread.

AJMC®:Can you discuss the importance of eye health amid the COVID-19 pandemic? I know you just alluded to the older population, but how can better management of eye-related issues assist Americans during this time?

Laroche: Well, the leading causes of blindness are cataracts, glaucoma, diabetic retinopathy, and macular degeneration. During this period of time, people still need access to eye care. They still need to be able to see their doctors. I'll give an example of a tragic situation that happened recently.

I had a patient who was 91 years old–I did cataract and glaucoma surgery on 1 eye and she was doing great. She was scheduled to have the other eye done before the lockdown. Her pressures were high, so it was a little bit urgent for us to have the surgery done, but she was scared to have the surgery because of COVID. We shut down in New York, and all elective surgery was canceled, and at some point, urgent surgeries reopened again, and I wanted to bring her to the operating room, but she still was scared to come out because of COVID.

I recently saw her just last week and by the time I saw her, which is like a few months later now. she was completely blind in that eye. In New York City as well, we've had some people die at home from lack of access to care for heart disease–a variety of different things. People have lost vision from glaucoma allergies because they just did not come out because they were scared to come out.

So, the key thing is that we do telehealth. It’s very important for seniors to connect with their doctors via telehealth. Another problem that we had is that a lot of seniors don't have a smartphone or don't know how to use a smartphone. So, we've educated families to work with younger kids and the younger generation to work with educating the seniors on how to use a smartphone, how to communicate with their doctor to see if you do need to have something done urgently to come in.

If not, it's okay, you can delay care for 3 to 4 months and communicate that way. That's what we've done as well in office. So, we do telehealth visits for the high risk population. If they do need to come in because they have an unstable situation, we're able to give them instructions to wear masks–come on in, we have plexiglas, we have hand sanitizer here, we do social distancing in the office, and have them come and space them apart so they can feel safe and get the care that they need.

AJMC®: One significant issue that has resurfaced amid the pandemic are notable inequalities in COVID-related outcomes for minority populations. What are some steps that ophthalmologists are taking to ensure that eye health is maintained among these at-risk groups?

Laroche: Well, that's a big question. The health disparities that we're seeing in COVID-19 have really been here for hundreds of years in the United States–it's just that COVID-19 has really put a light on it, because the death rate amongst blacks and Afro Latinos are anywhere from 2 to 4 times higher. The reasons for that are due to many reasons.

One, lack of access to care, lack of health insurance, the fact that black and Afro Latinos make a higher percentage of essential service workers in supermarkets, transportation, deliveries, and so they're exposed to the virus. Also, there's a lack of minority health care providers as well. I'll give an example: there are about 41 million blacks in the United States, but as an eye surgeon there are only 400 black ophthalmologists. So, there's a huge lack of access to care. The other 26,000 ophthalmologists are dispersed–there's a huge mal distribution problem. Many of them are on the east coast, on the west coast, not as much in the south. Unfortunately, we have a lot of residential segregation and so many of them don't practice in black communities, so a lot of blacks don’t have access to specialist care.

So, we really need to relook at the whole system and revamp the whole system to address these issues on multiple fronts. That includes providing universal universal health care for everyone. So, people have access–equal universal health care, not tiered where someone has Medicare and someone has Medicaid because patients who have Medicaid usually have to go to a clinic–the next appointment might not be until the next 4 to 6 months, the student doctors, they are not getting the type of care that they can get when you have a Medicare type of insurance.

Increasing the number of black and Afro Latino physicians and specialists as well, and wrapping that up from a very young level. Doctors right now are maintaining the offices open, doing telehealth, trying to see patients to get people the care that they need, and doing something like this–educating people, educating practitioners, educating patients about the importance of getting an eye exam, getting checked for cataracts, glaucoma, diabetic retinopathy, those types of things.

The other thing someone could do is personal responsibility. We do have a high incidence of obesity in the community and in America as a whole. People that are obese, there's a higher death rate with COVID, and we are very early in the pandemic.

So, something that people can do at home and what I go over with my patients is weight loss. Diet, exercise, and specific recommendations–vegetable juice, within a blender, you can put cucumber, spinach, celery, blueberries, blend that into a drink. Drink that 2 or 3 times a day–that suppresses your appetite, gives you the excellent nutrients you need vitamin A, vitamin C, Vitamin E.

The other thing is you can take a zinc supplement, also to help strengthen your immune system, a vitamin D supplement–to fight off COVID when it comes your way. So the leaner you are and the more nutritious you are in terms of building up your immune system that's going to help you fight off the virus when it comes.

AJMC®: Additionally, can you speak on eye-related care among the general population? Are there distinct populations who are more at risk for eye issues?

Laroche: Yes, the elderly in particular, you want to make sure you get an eye exam once a year. Macular degeneration, cataracts, diabetic apathy, glaucoma, all big ones. People over the age of 40, you want to get your eyes checked to see if you need glasses, particularly for reading. We're all on computers right now with zoom. So, you want to make sure you have the correct prescription and you want to follow the 20-20-20 rule, which is every 20 minutes, look away from the computer for 20 seconds far off to help reduce strain on the eye. So that's one of the things that you want to do to help.

For the young kids, you want to do the same thing because young children when you're looking at the screen all day you can get increased myopia. So, it's very important for them to do outdoors activities–spend 30 minutes to an hour doing outdoors activities.

Every 20 minutes look at something more than 20 feet away for greater than 20 seconds. Take a break, walk around, hydrate yourself, and eat healthy foods.

AJMC®: What further steps are warranted to promote eye health and combat inequalities in health care among minority populations?

Laroche: Well, I touched on some of that already. I think we have to provide universal health care for everyone. We have to eliminate structural racism, housing, employment, and mass incarceration. In health, there are huge financial wealth disparities, the average white family net worth is about $170,000, net worth of black families is $17,000–that huge gap has to be bridged, because with increased wealth, you get increased health.

The average income of Asians, for example, make the most–as high as about $80,000 a year, whites is about 70,000, Hispanics is about $50,000, and blacks at $40,000. So, we have to try to bridge that gap. Unfortunately, part of that is there is some structural racism that underlies that. I'll give you an example: in New York City, Bronx High School of Science is a magnet high school, okay, that magnet high school produces the future doctors, the future lawyers, the future business people.

In that high school right now it's about 65% Asian, and only 3% black. Despite the fact that in New York, the black population is 26% and the Asian populations 13%. The sole reason for that is a standardized test score entry exam. That's a structural barrier that's creating these disparities. If these types of schools change the policy to say, hey, look, we're going to take the best students in each community–the best students in the Bronx, the best students from Queens, Brooklyn, Manhattan–if you just take the best of each high school that would immediately diversify to represent the population. So, those are the type of structural barriers we have to break down and change to ensure adequate equity across the board and stop some of the systemic discrimination that’s taking place. So, those are some of the basics.

Also, all government funding. All government funding of corporations, health institutions should be tied to diversity. For example, a vaccine company recently got $1.5 billion from the government. Part of that money should be tied to employing a diverse workforce and training a diverse workforce right there–that will help solve the problem. We're not thinking like that, but we have to think outside the box because that type of investment is going to make our society better and help reduce disparities.

I mean, we're in a tough time right now in the era of COVID. We have a lot of poverty, people are suffering. People have lack of access to food, lack of access to jobs, lack of access to income. Martin Luther King talked about providing a universal income where people can get a stipend of maybe $400 a week if they're below the poverty line. I think we have to think like that–these temporary stimulus incomes are good for the short term, but I think we need to have a more permanent solution like that to reduce poverty. That's a big issue that we're having at least in all these equities. John F. Kennedy, Robert Kennedy, Martin Luther King–they were all working on that, but they all got assassinated and we're right back here to where we are now. So, we have to revisit those types of things to help bring forth equality.

AJMC®: For people seeking eye care how can they get in touch with you?

Laroche: They can visit my website at www.advancedeyecareny.com or glaucomamd.com. You can google Dr. Daniel Laroche and my information should come up.

AJMC®: To learn more, visit our website at ajmc.com. I’m Matthew Gavidia, thanks for joining us!