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COVID 19 – a situation in flux for ophthalmologists

These are worrying times for ophthalmologists who are working against all odds to look after their loved ones, their colleagues and their patients

Colin Kerr

Posted: Monday, March 23, 2020

 

Photo by Foto Garage AG on Unsplash

“These are worrying times for ophthalmologists who are working against all odds to look after their loved ones, their colleagues and their patients,” said Professor Rudy MMA Nuijts, President of the European Society of Cataract and Refractive Surgeons.

“The society is committed to giving ophthalmologists every support in the coming days, weeks and months and as part of this initiative EuroTimes, the official news magazine of the society, is publishing daily online updates on how the virus is affecting ophthalmologists in their daily practices and how they can prevent the spread of the virus.”

“We urge all ophthalmologists to follow the guidelines issued by the World Health Organisation and other professional bodies and to also keep up to date with the latest scientific literature. EuroTimes, will also be publishing a review of the literature as it emerges.

Protect The Eyes
Dr Rahil Chaudhary, Medical Director Ophthalmologist at Eye7 Hospitals, New Delhi, India says one thing that needs more emphasis is that the eyes needs to be protected.

“If a droplet comes in contact with conjunctiva it can enter the body by the mucosa. We are using universal eye protection in the clinics as well in addition to masks but the same should be adopted by general population as well who are just wearing masks,” said Dr Chaudhary in a post on Facebook.

While official advice and protocols vary from country to country, the World Health Organization (WHO) has recommended using protection for the mouth, nose and eyes when caring for patients potentially infected with COVID-19, and self-isolation for 14 days for anyone suspected of being in contact with an infected person.

Dr Florian Kretz, Chief Executive Officer & Lead Surgeon at Eyeclinics Ahaus-Greven-Raesfeld-Rheine, said in Germany ophthalmologists are in emergency mode operating with minimum staff.

“We will only see emergencies and patients that need treatment like intravitreal injections. Glaucoma patients that need prescriptions get their air pressure tonometry and prescription,” he said in a post on the ESCRS Young Ophthalmologists group.

Arthur Cummings, Consultant Ophthalmic Surgeon & Medical Director, Head of the Department of Ophthalmology Beacon Hospital, Dublin, Ireland told EuroTimes that his clinic was still doing its cataract lists this week but may not be doing so next week.

“We will take guidance from the authorities and the hospital. We have, however, called all elderly patients or patients that are in any way compromised and postponed their surgery indefinitely,” he said.

“At the moment laser refractive procedures are still being performed around the globe as long as patients meet all the screening criteria: no temperature, no symptoms, no exposure to anyone with COVID-19, no flights or being part of a crowd (sports, concerts) in the past two weeks. As this is a situation in flux, our situation could be quite different,” said Dr Cummings.

Guidance documents

The European Centre for Disease Prevention and Control (ECDC) has also issued guidance documents on infection control and personal protective equipment (PPE) needs in healthcare settings where patients suspected/confirmed of COVID-19 infection are being treated, as well as regular updates on the spread of the disease (www.ecdc.eu). Expert advice is also being shared by the Royal College of Ophthalmologists.

Speaking to EuroTimes, Dr Cillian De Gascun MD, Medical Virologist and head of Ireland’s COVID-19 Expert Advisory Group, said healthcare professionals need to ensure good infection prevention and control practices as standard, and take appropriate contact and droplet precautions, particularly for direct contact with potential COVID-19-infected patients. “We’re still learning about this novel coronavirus and how transmissible it is. What doctors and hospitals need to do, first of all, is try to prevent contamination of surfaces, and infection of individuals so that means protecting the mucus membranes and good hand hygiene,” he said

Standard infection protection measures “do work and are effective” on SARS-CoV-2, and there is no evidence it is particularly resistant to existing decontamination methods, Dr De Gascun stressed.

Eye protection
“As so often is the case, ophthalmologists often lead the way and in the case of this coronavirus it is interesting that it was an ophthalmologist who picked up the disease well ahead of anyone else and sadly contracted the condition from an asymptomatic patient and later died,” Dr Sheraz Daya FRCOphth, Medical Director, Centre for Sight clinics, UK, told EuroTimes.

“We as ophthalmologists are at considerably high risk, considering we are in close proximity to patients when examining them and transmission can be through mucous membranes, including the eyes,” said Dr Sheraz Daya FRCOphth, Medical Director, Centre for Sight clinics, UK.

“I have been trying to figure out how perhaps to adapt a slit lamp and install a large protective barrier between the oculars and the examination stage. The small barrier that exists on some slit lamps is woefully inadequate.”

Dr Daya’s practice has been monitoring the international situation closely and following UK Department of Health guidance.

“It makes sense for all coming into close contact [with patients] to wear eye protection and consider wearing effective face masks”, Dr Daya said.

A large clear plastic sheet with a hole cut into it placed between the ocular and slit lamp. Courtesy of John SM Chang MD

Some practical tips for the ophthalmologist from Dr John Chang

The Goldman applanator (not only the tip but also the black housing) can touch the patient’s mask or mouth and transmit the virus to the examiner, so care should be taken to avoid not touching the applanator housing and sterilise it every time it is used.

A large A4-sized clear plastic sheet made for book binding covers can be purchased from any stationary store and a hole can be cut to fit between the ocular and slit lamp. One of our Hong Kong ophthalmology colleagues used his old MRI scan and mounted it on to his slit lamp!