French surgeons believe in the future - EuroTimes

French surgeons believe in the future

On Tuesday, March 17, French President Emmanuel Macron declared a 15-day lockdown, ordering people to stay at home unless they need to buy groceries, travel to work, exercise or seek medical care.

Béatrice Cochener-Lamard MD, PhD, told EuroTimes how the lockdown and the COVID-19 crisis are affecting ophthalmology and provided her insights on implications for the future. Dr Cochener-Lamard is Professor and Chair, Department of Ophthalmology, University Hospital of Brest, Brest, France.

What does the lockdown mean for ophthalmologists in their daily practices?

Prof Cochener-Lamard: The situation has led all specialties to massive deprogramming of surgeries and consultations, keeping open only a channel for medical and surgical emergencies. This reduction in usual activity was initiated last week, before the lockdown, in the interest of citizens’ attitude aimed at limiting circulation of the population and therefore of the virus.

The medical community is showing an enormous mobilisation and a great surge of solidarity, and caregivers are offering their services in areas other than their specialties. For example, ophthalmologists are involved in the telephone regulation of emergencies and in screening centres.

Not all regions in France are affected to the same extent by the virus, but the examples from Italy put all hospitals in battle order, ready to deploy the capacity to care for the sick, support saturated areas, and prepare for the fight against this virtual enemy. As in many countries, the first fight is to ensure the protection of exposed individuals, starting with healthcare personnel. We are also alerting people to ensure that they have sufficient supplies of masks and alcohol-based solutions.

What is the future of French ophthalmology after COVID-19?

Prof Cochener-Lamard: If in this unprecedented war, the sense of fraternity and commitment, which has characterised France through many battles, is expressed through touching support initiatives (such as a heartfelt tribute honouring hospital teams paid by citizens on the balconies of major cities each evening), it is certain that the country, like the rest of the world, is anxious to advance towards the unknown in terms of the weapons to be deployed, the appropriate strategy to adopt and the time it will take to achieve the eradication that everyone dreams of.

What everyone fears above all is having to reintegrate the effect of the deprogrammed activity into the already busy agendas. This concern is especially high in ophthalmology where the average waiting time for an appointment is at least six months. As seen in previous world wars, we fear that confined patients with conditions such as glaucoma, diabetes, maculopathies and amblyopia will have abandoned self-care so that they develop irreducible pathologies.

If the crisis lasts several months, it is likely that some practices will be economically threatened and have difficulty retaining their staff, including secretaries, nurses, and orthoptists, which many doctors in private practice had to send home.

On the other hand, we dare to imagine that the positive lesson of this tragic period will be that the population gains a better civic sense and develops more responsible behaviour with regard to the rules of hygiene and respect for others.

We are all aware that we are writing a sad page in the history of mankind. It is certain that French ophthalmology will be happy to go back to work and will redouble its energy to make up as best it can for the time lost and the delayed care.

What is the future for research and training?

Prof Cochener-Lamard: Of course, there is currently no question of initiating a clinical trial or enrolling patients into ongoing trials. Every effort is being made, however, to monitor existing study participants.

We want to believe in the future and continue to design the research work. Everyone is invited to use spare time not dedicated to the hospital to work on analysing clinical data collected before the crisis, writing about the state of the art and analysing the literature.

Regarding education, from primary school to university, and therefore a fortiori for medical students, residents, and fellows, courses are being maintained online and sometimes in small groups for the hospital team while respecting the necessary hygiene barriers. Currently, defence dates for examinations, theses and certification have been postponed until after May. They will happen.

What are you telling your trainees? 

Prof Cochener-Lamard: We do not need to tell them that they are going through a unique period in history, because spontaneously, they are generous and offer their energy and time. We can be proud of our young ophthalmologists. They will surely represent a particular generation having been enriched by this human tragedy from which they will emerge grown.

Our trainees are aware that the coming months may not be devoted solely to learning their specialty and that they will be mobilised on other fronts. They are staying the course by dividing their time between emergency management, supporting activities around COVID-19 and deepening their basic knowledge. Depending on the duration of the crisis, the Ministry of Education may discuss offering trainees an additional six months of conventional training in ophthalmology. We hope we do not have to use it!

In case of ophthalmic emergencies, where can patients be treated? 

Prof Cochener-Lamard: Emergency lines are being maintained by hospitals and several clinics.

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