Background
Multidisciplinary clinics are common in clinical genetics practice, as they allow the expertise of multiple providers within a single visit and enable improved coordination of care and patient experiences. Our team initiated a combined Ophthalmology Genetics clinic during the COVID-19 pandemic, requiring creativity to enable appropriate social distancing in the context of spatial constraints. The goal of this clinic is to provide comprehensive ophthalmologic and genetics care for individuals with both syndromic and nonsyndromic ocular differences.
Case presentation
The clinic began in July 2020. Our institution had imposed work room personnel limitations to allow social distancing to prevent the spread of COVID-19. As a result, our clinic model involved a hybrid approach. Patients were first evaluated by the pediatric ophthalmologist (in clinic) to enable a thorough examination and discussion of ocular findings. The pediatric geneticist and genetic counselor (with trainees, if present) were then incorporated in the visit via Zoom, with an iPad in the patient exam room. The pediatric ophthalmologist summarized findings with the family and genetics team. The genetics team then reviewed medical and family history, and physical exam was in part visual inspection by the geneticist as well as in-person examination by the ophthalmologist. Testing strategies were then discussed and counseling provided.
The clinic has met on average one per month, and thus far 32 patients have undergone evaluation. Referrals have come from both inside and outside of the institution. Referrals to both genetics and ophthalmology are reviewed and appropriate patients routed to the multidisciplinary clinic. The most common reasons for referral have included congenital cataracts (n=6), anterior segment dysgenesis (n= 5), coloboma (n=2), megalocornea (n=2), and microphthalmia (n=2). Testing strategies have varied based on reason for referral, including chromosomal microarrays, single gene testing, gene panels, and exome sequencing.
Conclusion
The hybrid model has served the clinic well to date. It allows for communication between providers during the visit and in a transparent manner, as the patient/family is present during this communication. It has also enabled all providers to be “present” simultaneously, which would otherwise be discouraged for social distancing purposes. The multidisciplinary model allows for more accurate ocular phenotyping to inform the genetic testing approach. While dysmorphology examination by the geneticist is somewhat limited through the video, it is supplemented by the in-person evaluation of the ophthalmologist. The hybrid clinic model could also be useful in future implementation of multidisciplinary clinics across different campuses or sites as well. Further research is needed to assess patient experiences.