Bruce Allan MD
Bruce Allan MD, is a Consultant Ophthalmic Surgeon at Moorfields Eye Hospital, London, England. In a Q&A with EuroTimes, Dr Allan talked about how the COVID-19 pandemic is affecting patient care, ophthalmology research and training in the UK. Maintaining a positive outlook, he shared ideas about the opportunities that the crisis is creating.
How is the pandemic affecting ophthalmologists in their daily practices, public and private?
As part of the rapid escalation of the UK response to COVID-19 over the past two weeks, we are, as of Monday, carrying out only urgent sight- or life-threatening care. All elective surgical and outpatient care is postponed, using a risk stratification process to ascertain which patients are safe to defer.
For corneal, cataract and refractive surgeons, this effectively means postponing NHS work and private practice, limited postoperative review and continuing care for active inflammation or infection only in the corneal clinics. As general hospitals repurpose to increase intensive care provision, part of our role at Moorfields as a specialist eye hospital will be to support them by taking on more of the ophthalmic emergency work from the rest of the region.
In case of emergencies (eg., retinal detachment, trauma), where can patients be treated?
For anything sight-threatening, we are continuing to work normally, albeit with additional precautions centred around minimising the risk of virus transmission during care.
What are your concerns about the impact on patients who may not be able to get in for their appointments?
Patients with ongoing sight-threatening problems will continue to be seen. We will be able to substitute video and telephone consultations for most routine postoperative review appointments. If patients have no “red flag” symptoms, and have finished their postoperative medication, there should be no special risks in this approach. For patients on long-term topical steroid treatment, post-keratoplasty for example, we will need to find a safe way of maintaining periodic monitoring of intraocular pressure (IOP).
The initial thought was that patients could visit their local optometrist for an IOP check, but many optometric practices are shutting down. Therefore, it may be necessary to create a dedicated “minimal contact” approach in which patients are monitored at Moorfields in a clinic separated from the services that remain open in order to maintain social distancing. With the situation changing almost daily through last week, we do not yet have all the contingencies fully worked out, but these are the lines of thinking.
Naturally we are also very sympathetic to the disappointment of patients who have been waiting for surgery and now find that it has to be postponed. Most patients are very aware of the tough situation we are in and are keen to pull together with everyone else to get through this.
How is the pandemic affecting trainees and research at Moorfields?
Sadly, all teaching meetings have been cancelled while the policy of social distancing remains in place. The exams for trainees have been cancelled, and the labs at the Institute of Ophthalmology have also closed.
I am telling the trainees what I always have – you never stop learning, and while everything is on hold academically, there are plenty of really good resources online. Now is actually a very good time to put the hard yards in for the professional exams (when they come back).
Our ophthalmic trainees are a significant part of the Moorfields response to this crisis, working in eye casualty. Some junior trainees have been redeployed by their host trusts to provide general medical services on the wards. For the senior trainees, it is a great opportunity to follow up or develop an academic or clinical interest to roll into their future career. The starting point is always a systematic review. So look for a flash of inspiration and then dive into the literature. The most important thing is to be fearless about this, and not assume that all the good ideas are already out there. A naïve perspective is often the most original. Just have a swing at it.
How do you expect routine care, training, and research will be affected in the future?
Normal service will be resumed at some point. Clearly the economy will be affected, and this will impact on research budgets. There will also be a clinical backlog to catch up on. Little by little though, we will get back on track. I am very much looking forward to seeing my Friday morning tutorial group again, and working alongside all the bright young people from all over the world who come to train with us at Moorfields.
So, as we Brits like to say, chin up everyone – we’ll get through this!
What is the future of ophthalmology in your country after COVID-19?
My hope is that being forced to look at what we really need to keep doing in order to practice safely will help us to look after our patients more efficiently in the future. For example, although we are using virtual consultations at this stage, we are also looking at further telemedicine solutions to help us reach our patients.
For UK medicine more widely, if ever we needed a reminder of the need for continued international collaboration, this is it.