In the middle of the ongoing COVID-19 pandemic, Indian ophthalmologists face a unique challenge. Most patients we see are in the vulnerable group – elderly and most often with comorbidities. Close contact between patient and doctor on the slit lamp as well as with other medical staff during investigations is inevitable. There is generally more than one investigative machine kept in one room, thereby resulting in multiple patients, optometrists and staff being in the same room.
In our hospital, we have taken multiple measures in view of the risks involved. Educating staff and doctors about the disease and preventive measures as well as educating patients and attenders to avoid unnecessary visits, avoid touching face as they constantly otherwise tend to do are uppermost.
Since coronavirus has been detected in tears, it has disrupted traditional patient care that involves lifting up eyelids to examine or apply eye-drops, performing aerosol-generating procedures like non-contact tonometry etc. We have instructed doctors, residents, optometrists and staff to avoid these or use gloves. Patients are instructed to strictly no-touch tissues that they use to wipe their eyes on any object. Sterilisation of the applanation tonometry tip, gonioscopes, B-scan and A-scan probes etc between patients is more vital now than ever. The forehead and chin-rest of the slit lamp is wiped down with alcohol wipes after every patient. A slit lamp shield made out of a simple file folder (a five-minute hack that can be done by the ophthalmologist himself) is used to separate the patient from the surgeon. An ear-bud serves as a simple and disposable measure to lift the patient’s upper eyelid for examination.
Patients and attenders are advised to wait in less crowded places and even outside the clinic until it’s time for their appointment. Policy decisions regarding patient care, sick leave, work-flow management etc. have also been taken. Staff have been advised not to report for work if they feel sick. Large meetings, postgraduate teaching, journal clubs etc have been temporarily suspended. Urgent and postoperative reviews are still being maintained, though many have cancelled elective surgeries. Our EMR system records patient address and mobile number for all patients so that contact tracing if required can be easily done.
Most of these measures are also being taken by other ophthalmologists in the country. As of now, most are responding by asking patients to delay routine reviews; avoid coming in case of recent history of travel, contact with anyone with a travel history or any positive symptoms; decreasing the number of attenders with each patient, providing mask and hand sanitisers to staff and patients and stepping up disinfectant activities in the hospital including wiping down chair arms, door handles, slit-lamp handles etc at frequent intervals. Biometric attendance has been eliminated in some places and hand sanitisers are kept prominently for use. Some clinics have put up infra-red thermometers at the entrance and are pre-screening right at the entrance.
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