As France moves into full lockdown in response to the coronavirus pandemic, the French Society of Ophthalmology held a special webcast for its members to help them deal with the crisis.
Prof Isabelle Cochereau, an ophthalmologist of the Rothschild Foundation Hospital in Paris, outlined the latest official recommendations of the French Academy of Ophthalmology.
She noted that ophthalmology has been deemed a profession at increased risk in terms of COVID-19 because of a number of factors: examination of the patient at a proximity of less than one metre for a duration of longer than 15 minutes with the subsequent risk of exposure from droplets from the patient, and also the necessity for the practitioner to place their hands on the patient’s face and eyelids.
Particular vigilance is required in the presence of conjunctivitis, as the data from China indicates that conjunctivitis develops in about 1-to-3% of people with coronavirus and may possibly be transmitted by aerosol contact with conjunctiva.
Protective masks, either standard surgical masks or N95 filtering facepiece (FFP2) masks, should be worn at all times and changed every four hours. Other recommended measures include installing a plastic shield at the slit lamp, as well as using personal protective equipment such as gloves, gowns, overshoes and eye goggles. All material should be fully disinfected between each consultation.
It is recommended to postpone all non-urgent surgery in hospital settings and to vastly reduce consultations where possible. For private practices it is advised to reduce practice levels to the minimum while remaining available to treat emergencies such as retinal detachment, trauma or cases of severe infection.
Practices should continue operating only if all of the requisite sanitary requirements can be fulfilled: i.e. masks for the whole team, repeated disinfection, adequate distance between patients, suitable waiting rooms to filter patients etc.
Special care is needed for patients at particular risk from COVID-19 – i.e. elderly patients and those with comorbidities. Such patients need to be identified before coming to the clinic and their consultations need to be rapid and carried out in an isolated circuit with maximum protective measures for their care.
Patients who come to an appointment should be asked prior to entering the waiting room about possible COVID-19 symptoms (fever, cough, respiratory problems). Patients with symptoms should be sent home and told to speak to their primary care physician.
If a patient with known COVID-19 infection needs urgent ophthalmic care, they should be equipped with a mask and ideally treated in a hospital setting with full infection control conditions.
The need to protect the profession is all the more pertinent in that many French ophthalmologists fall in the older age bracket and are themselves at risk of developing a more severe form of COVID-19, said Prof Cochereau.
She ended her talk by paying tribute to Dr Li Wenliang, the Chinese ophthalmologist at Wuhan Central Hospital who was the first to warn fellow colleagues of a possible outbreak of a SARS-type illness and who died from COVID-19 after being infected by a patient with acute angle-closure glaucoma.