The COVID-19 pandemic: Important considerations for contact lens practitioners

Continued changes to contact lens practice following adjustments made as a result of the COVID-19 pandemic

Background

This study aimed to explore behaviour of practitioners in response to the COVID-19 pandemic, analysing the factors that influenced their decisions to resume professional practice post-lockdown and intention to adhere to COVID-19 protective measures.

Methods

A web-based cross-sectional survey targeting Italian practitioners was carried out to study the post lockdown behaviour and future intention to provide new contact lens (CL) fittings, and the use of protective measures. The survey also explored the dimensions of the Integrated Behavioural Model (IBM) and the Health Belief Model (HBM) to predict the intention to resume professional practice and to comply with protective measures respectively.

Results

A total of 212 professional (150 males; age range 22-76 years) completed the survey. Past behaviour and positive attitudes toward CL practice were the variable in IBM that predicted more strongly the intention to provide both new CL fittings and aftercare visits, whereas past behaviour and perceived benefits of HBM were the strongest predictors of future compliance with protective measures.

Conclusion

Results suggest that the more engaged practitioners are more willing to get back to their routine even in uncertain circumstances, and that a tailored approach, leveraging past behaviours and perceived benefits, could enhance compliance strategies.

YouTube as a learning source for contact lens insertion and removal

CLINICAL RELEVANCE

Contact lens neophytes often learn about contact lens insertion and removal through YouTube videos of unknown quality.

BACKGROUND

This study evaluates the quality of soft contact lens insertion and removal videos on YouTube.

METHODS

A search for the keywords 'Contact lens insertion', 'Contact lens removal', 'Put in contact lens', and 'Take off contact lens' was performed on YouTube. The first 50 videos for each keyword were evaluated. The number of views, source of the publisher, days since upload, and video quality were scored based on the content in the videos. The maximum score of insertion and removal videos were 7 and 5 respectively. The videos were classified into three groups by publisher category: videos published by eye care professionals, companies and YouTubers.

RESULTS

Only 45 contact lens insertion and 44 removal videos met the inclusion criteria and were analysed. Insertion and removal videos published by YouTubers had the highest view and view rate. However, their quality scores were significantly lower than videos published by eye care professionals and companies. Videos uploaded by companies had the highest scores (insertion: 5.00 ± 1.10; removal: 3.25 ± 0.75). The mean scores of insertion and removal videos published by YouTubers were 1.65 ± 0.93 and 1.00 ± 0.89, respectively, while the insertion and removal videos uploaded by eye care professionals scored 3.58 ± 2.07 and 2.75 ± 1.53, respectively. There was also a negative correlation between the quality scores and view rate (p = 0.008, r = -0.41).

CONCLUSION

Contact lens insertion and removal videos uploaded by YouTubers had the highest view rate but the lowest quality. Videos made by companies included most essential elements.

Impact of COVID-19 pandemic on a world-wide private ophthalmic practice

Purpose

To assess the impact of the COVID-19 pandemic on a worldwide private ophthalmic practice.

Design

In this retrospective study, we reviewed the 2020 monthly outpatient and surgical volume of refractive, cataract, and retinal disease in Aier Eye clinics/hospitals of different regions, including the United States, Germany, Spain, Italy, and six major cities in China (Wuhan, Beijing, Shanghai, Shenyang, Urumqi and Yili). All of these data were compared to those of the same period of 2019.

Results

Overall, during the early stage (2020 January to 2020 April) of COVID-19 outbreak, the outpatient and surgical volume of three main type ocular diseases (refractive, cataract and retinal surgery) showed an obvious reduction and reached the bottom in February in China. The data from the United States, Germany, Spain and Italy revealed the same trend, but the visit count nadir occurred until April, which is consistent with the spread trend of COVID-19 disease around the world. The average change rates of surgery volume (refractive, cataract and retinal surgery) in Chinese centers are 5.59%, -26.38%, 11.76%. The change rates of refractive (REF) and cataract volumes (CAT) in the United States are -8.62% and -10.58%, in Germany are -13.71% and -20.49%, in Spain are 15.35% and 27.97%, in Italy are 30.43% and -22.64%. In addition, the optometry outpatient volumes keep going up since May, with an average increasing rate of 21.18%, ranging from 7.43% to 49.51%.

Conclusion

In conclusion, in this global chain of eye care units, the visit volumes of cataract, retinal and refractive changed significantly with the spread of COVID-19 pandemic. Among them, cataract surgery was the most affected sub-specialty, and refractive surgery and optometry volumes showed a potential growth in the near future. Therefore, medical institutions should make corresponding adjustments to the disease diagnosis and treatment strategies.

Advances in Contact Lens Care Solutions: PVP-I Disinfectant and HAD Wetting Agents From Japan

ABSTRACT

Half of the individuals who wear contact lenses use reusable lenses that require proper care. Improper contact lens (CL) care and using inadequate disinfecting solutions can lead to lens contamination, CL-related microbial keratitis, and Acanthamoeba keratitis. Oxidative disinfecting solutions, such as hydrogen peroxide, show higher efficacy than multipurpose solutions. Povidone-iodine (PVP-I), an oxidative disinfectant used in ophthalmic surgery, has been proven to be safe and effective. The PVP-I system, a CL disinfecting solution developed in Japan, has demonstrated excellent antimicrobial and antiviral properties. Although CL discomfort does not have a risk of ocular disorders with poor visual prognosis, such as keratitis, CL discomfort can still lead to lens dropout and thus needs to be addressed. To mitigate CL discomfort, it is essential to use disinfecting solutions containing surfactants and wetting agents that improve wettability of the lens surface. A CL solution containing hyaluronic acid derivatives (HADs) as wetting agents that permanently adhere to the lens surface to improve wettability of the lens surface was developed in Japan. There is potential for HAD to be integrated into various solutions. This article reviews the efficacy of novel PVP-I-based disinfecting solution and HAD wetting agents.

Vision Correction Habits After COVID-19 Onset in Spectacle and Contact Lens Wearers

PURPOSE

To determine how vision correction habits changed after the 2019 coronavirus disease (COVID-19) pandemic onset.

METHODS

Participants reported vision correction habits, refractive error, screen time, mask wearing time, and dry eye symptoms since the COVID-19 pandemic onset through email survey.

RESULTS

A total of 133 participants completed the survey. Worsening dry eye symptoms were associated with increased screen time ( P =0.04). Hours per day of spectacle wear increased by approximately 1 hr ( P =0.001) and was associated with increased screen time ( P =0.002). Worsening dry eye symptoms were associated with increased days per week of spectacle wear ( P =0.02). Participants wore contact lenses about one day per week less than before the pandemic ( P =0.0001). Increased mask wearing time was associated with increased days per week of contact lens wear ( P =0.03).

CONCLUSIONS

After pandemic onset, hours per day of spectacle wear increased, and days per week of contact lens wear decreased. Increases in hourly spectacle wear were associated with increased screen time, whereas increased daily contact lens wear was associated with increased mask wear time, suggesting that spectacles may be preferred for screen time activities and contact lenses for mask wear.

Correlation Analysis of Surface and Physical Properties of Ophthalmic Lenses Containing Nanoparticles

Since contact lenses directly contact the cornea, the surface roughness of the lens may cause various side effects. In addition, gold nanoparticles can realize a variety of colors and characteristics depending on their shape and size. In this study, the surface roughness of tinted lenses containing gold nanoparticles of various sizes was analyzed using atomic force microscopy (AFM) at aspect ratio(surface to volume ratio) ranging from 1:1 to 1:10. The characteristics of the lenses were then confirmed. As a result, tinted lenses with different colors depending on the size of the gold nanoparticles were manufactured. The surface roughness of the lens decreased with increasing size of the gold nanoparticles. However, at aspect ratio of 1:10, increase in surface roughness was observed. In addition, it was confirmed that the wettability and antibacterial properties of the lens had the same effect according to the average surface roughness value. Therefore, it was confirmed that the addition of gold nanoparticles reduced the surface roughness of the lens, which had a great effect on properties such as wettability and antimicrobial properties of the lens. The produced copolymer controls the surface roughness of the lens, and thus it is judged that it can be used as a material for various ophthalmology applications.

Persistence of Coronavirus on Surface Materials and Its Control Measures Using Nonthermal Plasma and Other Agents

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been responsible for the initiation of the global pandemic since 2020. The virus spreads through contaminated air particles, fomite, and surface-contaminated porous (i.e., paper, wood, and masks) and non-porous (i.e., plastic, stainless steel, and glass) materials. The persistence of viruses on materials depends on porosity, adsorption, evaporation, isoelectric point, and environmental conditions, such as temperature, pH, and relative humidity. Disinfection techniques are crucial for preventing viral contamination on animated and inanimate surfaces. Currently, there are few effective methodologies for preventing SARS-CoV-2 and other coronaviruses without any side effects. Before infection can occur, measures must be taken to prevent the persistence of the coronavirus on the surfaces of both porous and non-porous inanimate materials. This review focuses on coronavirus persistence in surface materials (inanimate) and control measures. Viruses are inactivated through chemical and physical methods; the chemical methods particularly include alcohol, chlorine, and peroxide, whereas temperature, pH, humidity, ultraviolet irradiation (UV), gamma radiation, X-rays, ozone, and non-thermal, plasma-generated reactive oxygen and nitrogen species (RONS) are physical methods.

TFOS Lifestyle: Impact of contact lenses on the ocular surface

Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.

Opportunities and threats to contact lens practice in Spain

OBJECTIVE

An international survey evaluated the opportunities and threats related to contact lens practice reported by eye care professionals worldwide. This study reports on the results specifically found in Spain and how these compare with those from other regions of the world.

METHODS

A questionnaire was distributed to eye care practitioners around the world through professional associations. The questionnaire consisted of 9, 5 and 12 questions about opportunities, interventions, and potential threats related to contact lens practice, respectively.

RESULTS

A total of 2,408 responses were obtained from practitioners worldwide, of which 436 responses were obtained from Spanish practitioners. Spain was found among the regions with the highest perception of opportunities (median: 6.5/10) along with Australasia, North America, Europe, and South America. Spanish (median: 7.3/10), along with South American practitioners, also reported the highest perception of threats. Continuously updating of knowledge/skills, recommending contact lens wearing options to potential patients, creating an efficient recall system for follow-up examinations and being competent in managing contact lens-related complications were reported as important interventions for contact lens practice growth by Spanish eye care practitioners.

CONCLUSIONS

Spain is one of the regions in the world with the highest perception of both opportunities and threats regarding future contact lens practice. As such, Spanish practitioners consider it important to continuously update knowledge/skills and to recommend and educate patients on the benefits of contact lens wear. Online sales were found to be one of the most important concerns reported by both Spanish and eye care practitioners worldwide.

COVID-19, mobility restriction, and sexual behavior among a cohort of people of reproductive age: Nigeria

Background

One of the non-pharmaceutical strategies adopted by various governments to control the spread of COVID-19 is mobility restriction (MR), popularly known as a lockdown. Evidence shows that MR has some unintended consequences, such as increased cases of domestic violence, rape, pornography, sex chats, incest, and other unhealthy sexual behaviors (SBs).

Methods

The study examined the influence of MR on SB in Owerri via a cross-sectional quantitative approach. A total of 425 interviewees were randomly chosen among people of a reproductive age. Data were analyzed using univariate, bivariate, and multivariate levels of analysis.

Results

A significant relationship exists between selected socio-demographic characteristics, such as age and marital status, and the ability of people to cope with sexual abstinence. Results from the logistic regression analysis further illustrated this observation as during MR people were twice as likely to engage in prolific sex chats that could spur other harmful SBs.

Conclusion

It is recommended that people should be allowed to determine whether they would like to stay with their partners in subsequent lockdowns, or otherwise, to prevent some of the unpleasant SBs recorded.

Eye-Related COVID-19: A Bibliometric Analysis of the Scientific Production Indexed in Scopus

This paper analyzes, from a bibliometric viewpoint, those publications that relate COVID-19 and eye indexed in Scopus since the beginning of the pandemic, and it identifies the resulting main research lines. A bibliographic search in the Scopus database was conducted for publications that simultaneously include ocular and visual manifestations and aspects with COVID-19, from 1 January 2020 to 16 March 2021, and the obtained bibliographic information was processed with VOSviewer (v. 1.6.16). A total of 2206 documents were retrieved, and 60% were original articles. The USA published the most studies (24.6%). The retrieved documents had a total of 18,634 citations. The h index of the set of retrieved documents was 58. The Indian Journal of Ophthalmology was the most productive journal, while JAMA Neurology and The Lancet accounted for 20% of citations. Three keyword clusters representing hotspots in this field were identified. Eye-related COVID-19 research is an emerging field with plenty of scientific evidence whose growth is expected to increase as the aspects and manifestations of the disease, its treatment and the effect of vaccination on it become known.

Conjunctival Swab Findings in 484 COVID-19 Patients in Four Hospital Centers in Slovakia

Since 2020, the COVID-19 (Coronavirus Disease 2019) has quickly become a worldwide health problem. Ophthalmologists must deal with symptoms as well. For the positive detection in the conjunctival sac swab in COVID-19 patients hospitalized in Slovakia during March 2021 in four hospital centers, we used a test based on a polymerase chain reaction (PCR). In a group of 484 patients, 264 males (55%) and 220 females (45%) with clinical symptoms were identified with COVID-19 as a clinical diagnosis. The PCR test swab results from the conjunctival sac taken on the same day were positive in 58 patients (12%), 31 males (with a mean age of 74.6 ± 13.59 years) and 27 females (with a mean age of 70.63 ± 14.17 years); negative in 417 patients (86%); and 9 patients (2%) had an unclear result. The cycle threshold values comparing the nasopharynx and conjunctiva were also different in the group of all patients divided by age and gender. In COVID-19 patients the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was detectable using PCR test in the nasopharynx but also in the conjunctival sac swab, where the positivity rate was only 12%.

Inanimate Surfaces as a Source of Hospital Infections Caused by Fungi, Bacteria and Viruses with Particular Emphasis on SARS-CoV-2

The carriers of nosocomial infections are the hands of medical personnel and inanimate surfaces. Both hands and surfaces may be contaminated as a result of contact with the patient, their body fluids, and touching contaminated surfaces in the patient's surroundings. Visually clean inanimate surfaces are an important source of pathogens. Microorganisms have properties thanks to which they can survive in unfavorable conditions, from a few days to several months. Bacteria, viruses and fungi are able to transmit from inanimate surfaces to the skin of the patient and the medical staff. These pathogens include SARS-CoV-2, which can survive on various types of inanimate surfaces, being a potential source of infection. By following the recommendations related to washing and disinfecting hands and surfaces, and using appropriate washing and disinfecting agents with a broad biocidal spectrum, high material compatibility and the shortest duration of action, we contribute to breaking the chain of nosocomial infections.

Lab-on-a-Contact Lens: Recent Advances and Future Opportunities in Diagnostics and Therapeutics

The eye is one of the most complex organs in the human body, containing rich and critical physiological information (e.g., intraocular pressure, corneal temperature, and pH) as well as a library of metabolite biomarkers (e.g., glucose, proteins, and specific ions). Smart contact lenses (SCLs) can serve as a wearable intelligent ocular prosthetic device capable of noninvasive and continuous monitoring of various essential physical/biochemical parameters and drug loading/delivery for the treatment of ocular diseases. Advances in SCL technologies and the growing public interest in personalized health are accelerating SCL research more than ever before. Here, the current status and potential of SCL development through a comprehensive review from fabrication to applications to commercialization are discussed. First, the material, fabrication, and platform designs of the SCLs for the diagnostic and therapeutic applications are discussed. Then, the latest advances in diagnostic and therapeutic SCLs for clinical translation are reviewed. Later, the established techniques for wearable power transfer and wireless data transmission applied to current SCL devices are summarized. An outlook, future opportunities, and challenges for developing next-generation SCL devices are also provided. With the rise in interest of SCL development, this comprehensive and essential review can serve as a new paradigm for the SCL devices.

The impact of covid-19 on soft contact lens wear in established european and us markets

Purpose

To characterise changes in soft contact lens wearing habits during the COVID-19 pandemic.

Methods

A detailed online questionnaire was circulated to individuals aged 40–70 years, during the period April to May 2021. Data sampling took place in the United Kingdom (UK), United States of America (USA), Netherlands, Germany, France, Spain and Italy. Only data pertaining to individuals who were soft contact lens wearers were included. Data were extracted for questions relating to contact lens wearing habits pre- and during the COVID-19 pandemic, and expectations for future lens wear beyond the pandemic.

Results

Seven-hundred and twenty-eight individuals were identified as soft contact lens wearers of which six-hundred and nineteen wore a combination of contact lenses and spectacles. Most respondents indicated contact lens wear times had either remained the same (57.3%) or increased (9.8%) during the pandemic. The country with the greatest proportion of respondents decreasing wear time during COVID-19 was the UK (45.3%), and the least in the Netherlands (20.0%). The primary cause of decreased lens wear was attributed to leaving the home less often (70.0%), and the second most common reason due to concerns about hygiene (10.8%). Most respondents (83.9%), however, expressed a desire to return to pre-pandemic wear times once the pandemic was over.

Conclusions

Practitioner concerns about contact lens market recovery ought to be assuaged by the survey outcomes which show most individuals to have maintained lens wear during the pandemic. In view of the continued lens wear, as and when restrictions ease, ECPs may wish to encourage patients to return for routine check-ups that may have been missed due to the pandemic.

Antiviral Activity of Contemporary Contact Lens Care Solutions against Two Human Seasonal Coronavirus Strains

Background: Given that reports have suggested SARS-CoV-2 can be transmitted via conjunctiva, the ability of contact lens (CL) care products to reduce the infectiousness of two seasonal human coronavirus (HCoV) (HCoV-229E and HCoV-OC43) surrogates for SARS-CoV-2 was investigated. Methods: Biotrue and Boston Simplus (Bausch&Lomb), OPTI-FREE Puremoist and Clear Care (Alcon), and cleadew and cleadew GP (Ophtecs) were tested. Their ability to inactivate HCoV was evaluated using contact times of 4 and 6 h as well as 1% and 10% of virus inoculum. Results: Non-oxidative systems (Biotrue, Boston Simplus, and OPTI-FREE) did not exhibit a significant log10 reduction compared to controls for the two viral strains for either incubation time (all p > 0.05) when 10% tests were performed. For the 1% test, while Boston Simplus and OPTI-FREE exhibited a significant log10 reduction of both HCoV-229E (after 6 h) and HCoV-OC43 (after either 4 or 6 h incubation), those products showed less than 1 log10 reduction of the two infectious viruses. Oxidative systems based on hydrogen peroxide or povidone-iodine showed a significant log10 reduction compared with the controls for both HCoV-229E and HCoV-OC43 in all tested conditions (all p < 0.01). Clear Care led to virus inactivation to below the limit of quantification for tests performed with 1% of inoculum after 6 h incubation, while cleadew and cleadew GP led to inactivation of the two viruses to below the limit of quantification in all tested conditions. Conclusion: Oxidative CL disinfection systems showed significant virucidal activity against HCoV-229E and HCoV-OC43, while non-oxidative systems showed minimal ability to inactivate the HCoV species examined.

Severe Acute Respiratory Syndrome Type 2-Causing Coronavirus: Variants and Preventive Strategies

COVID-19 vaccines have constituted a substantial scientific leap in countering severe acute respiratory syndrome type 2-causing coronavirus (SARS-CoV-2), and worldwide implementation of vaccination programs has significantly contributed to the global pandemic effort by saving many lives. However, the continuous evolution of the SARS-CoV-2 viral genome has resulted in different variants with a diverse range of mutations, some with enhanced virulence compared with previous lineages. Such variants are still a great concern as they have the potential to reduce vaccine efficacy and increase the viral transmission rate. This review summarizes the significant variants of SARS-CoV-2 encountered to date (December 2021) and discusses a spectrum of possible preventive strategies, with an emphasis on physical and materials science.

Coronavirus disease (COVID-19) and conjunctival sac swab findings

Background

The purpose of this article is to evaluate the positivity of conjunctival sac swab by PCR (Polymerase chain reaction) test in COronaVIrus Disease 19 (COVID-19) patients.

Methods

Inclusion criteria of our study were COVID-19 patients hospitalized during March 2021 in inpatient wards at University Hospitals in towns Bratislava and Zilina, Slovakia. The conjunctival sac swabs collected by four ophthalmologists were stored for 24 h, then analyzed in the laboratory of the Department of Microbiology and Immunology, Jessenius Faculty of Medicine in Martin, Comenius University, Slovakia. The sampling apparatus, used for conjunctival sac swab, was the Dacron polyester swab.

Results

We examined one group of 302 COVID-19 patients, 168 Male (56%) and 134 Female (44%). The patients’ mean age was 66.3 ± 13.66 years, ranging from 25 to 96 years, and the mean length of hospital stay in our patients with a nasopharyngeal positive PCR test was 7.33 ± 4.76, from 2 to 24 days.

The PCR tests from the conjunctival sac swabs were positive in 33 patients (11%), negative in 259 patients (86%), and ten patients (3%) were with the unclear result. In the group of 33 positive patients were 17 males with a mean age of 74.6 ± 13.59 years and 16 females with a mean age of 70.63 ± 14.17 years.

The cycle threshold (C_T) values differed significantly between conjunctival sac swabs from the nasopharynx and the conjunctiva. Medians of the values were 25.1 (14.1, 32.1) and 31.5 (22.6, 36.6) (P <  0.001), respectively.

Conclusion

This study affirmed that in COVID-19 patients the SARS-CoV-2 was detectable with PCR test in conjunctival sac swab, but the positivity rate was only about one to ten cases (11%).

Knowledge and Awareness of the Coronavirus Disease and Perceptions Towards Ophthalmic Practice Among Ophthalmologists

Objective:

To investigate the level of awareness of ophthalmologists towards COVID-19 and their perceptions towards infection control in ophthalmic practice.

Methods:

A web-based survey was conducted using Google Forms during the month of December 2020. All ophthalmologists practicing in Sudan were invited to participate in the study. Participants who did not agree to the terms of the electronic consent form presented at the beginning of the questionnaire as well as those who did not complete the survey, were excluded from the analysis. Knowledge of causes, symptoms, and methods of transmission of COVID-19; ophthalmologists’ attitudes and perceptions towards COVID-19 and clinical practice, including contact lens practice, were assessed using a set of 26 multiple-choice close-ended questions.

Results:

Of the 307 participants, 77.4% were in the age range 30-40 years and 73% were contact lens practitioners. While 96.1% acknowledged the scientific name of COVID-19, 46.9% were aware of its cause. Ophthalmologists aged 40-50 years were more likely to agree that air-puffing tonometer risks infection spread (OR 1.62, 95% CI: 0.27-9.70, p<0.01). Ophthalmologists aged 30-40 years were more likely to agree that a slit lamp shield would reduce infection risk (OR 1.52, 95% CI: 0.33-6.96, p<0.01). Contact lens practitioners were more likely to perceive that frequent replacement contact lens use can increase the infection spread (OR 2.64, 95% CI: 1.17-5.94, p<0.01).

Conclusion:

Ophthalmologists in Sudan demonstrated a mixed level of knowledge of the causes, symptoms, and modes of transmission of COVID-19. While the majority were able to identify the protective measures generally required by medical practitioners and patients, there was a limited level of knowledge regarding protective measures specific to ophthalmic practices, especially when dealing with contact lenses. Official national guidelines about safe ophthalmic service provision during the COVID-19 pandemic are recommended.

Systematic review: SARS-COV-2 contagion prevention measures in vision health professionals

The disease, which originated from the SARS-CoV-2 virus, is primarily transmitted by direct contact with infected individuals. Visual healthcare professionals perform clinical practices that pose a significant risk of infection due to their proximity with patients during the examination. This systematic review aims to identify preventive measures that will aid in reducing the risk of infection during standard appointments between patients and visual health professionals. A systematic review was done for articles published in indexed journals from December 2019 to December 2020. The search for these articles was done in 3 electronic databases. As part of the search criteria, articles were selected if they had the keywords (SARS-CoV-2), (COVID-19), and coronavirus combined with ophthalmology, optometry, eye care, and the eye. Once duplicated and unrelated items were eliminated, 36 articles of interest were selected. Seven sections were described in detail: telephone screening, (COVID-19) triage, decreasing transmission within shared spaces, hand washing, use of personal protective equipment Personal Protective Equipment (PPE), cleaning of diagnostic instruments, and use of telemedicine. This paper helps healthcare professionals to better understand the context of the "new normal" clinical practice. Visual health professionals and their patients must adhere to norms and use the indicated PPE during the consultation to safeguard each other.

Antiviral effect of multipurpose contact lens disinfecting solutions against coronavirus

Purpose

To evaluate the antiviral potential of five multipurpose disinfecting solutions against coronavirus (mouse hepatitis virus, a surrogate for SARS-CoV-2 human corona virus).

Methods

Test solutions (Biotrue, renu Advanced [Bausch and Lomb], ACUVUE RevitaLens [Johnson and Johnson Vision], cleadew [Ophtecs corp.] or AOSept Plus [Alcon]) were mixed with the coronavirus mouse hepatitis virus at 10⁴ plaque forming units (PFU)/mL as the final concentration and incubated at room temperature for the specified disinfection time. Surviving virus from each sample was then quantified by standard plaque forming unit assay and the reduction of PFU for each disinfectant was compared to the phosphate buffer saline (PBS) treated negative control. A regimen test was also conducted using Biotrue.

Results

The three multipurpose disinfecting solutions Biotrue (containing PHMB and polyquaternium-1), renu Advanced (PHMB, polyquaternium-1 and alexidine) and ACUVUE RevitaLens (polyquaternium-1 and alexidine) did not kill the coronavirus at the manufacturers recommended disinfection time in the stand alone test. After treatment, the virus’s titer (3.8 ± 0.2 log₁₀ for Biotrue, 3.7 ± 0.1 log₁₀ for renu and 3.7 ± 0.2 log₁₀ for RevitaLens) was similar to the negative control (3.7 ± 0.1 log₁₀; p ≥ 0.996). AOSept Plus (hydrogen peroxide) and cleadew (povidone iodine) significantly (p < 0.001) reduced the numbers of coronaviruses to below the detection limit (i.e. killed 3.7 ± 0.1 log₁₀ viruses compared to control). However, there was a significant reduction (p = 0.028) in numbers of coronaviruses attached to lenses when using the regimen test with Biotrue.

Conclusions

This study shows that oxidative contact lens disinfecting solutions (i.e. those containing povidone-iodine or hydrogen peroxide) provide superior antiviral activity against a coronavirus surrogate of SARS-CoV-2, unless the full regimen test (rub, rinse, disinfect) is used.

Environmental disinfection against COVID-19 in different areas of health care facilities: a review

The coronavirus disease 2019 (COVID-19) originated in bats and human-to-human transmission through respiratory droplets and contact with surfaces of infected aerosol are the main ways of transmitting this virus. Until now, there is no effective pharmaceutical treatment; conclusively it is important to evaluate the types of applied disinfectants in different areas against Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), the virus that causes COVID-19. The aim of this review was to summarize the information about environmental disinfection for preventing of COVID-19. We performed a review of the science direct database to find articles providing information on disinfection used for SARS-CoV-2. The extracted results were given the original data on inactivation coronaviruses by disinfectants in different places of health care facilities. The final search recognized that five groups of disinfectants include: chlorine containing disinfectants, alcohol, UV irradiation, Hydrogen peroxide, and other disinfectant were used against SARS-CoV-2 in different environments. Among these groups, bleach (chlorine containing disinfectants) has the most applicability. Also, in many studies by using disinfectants with 62-71% ethanol can reduce coronavirus in contaminated areas. Furthermore, after the using of operating room for COVID-19 patients, hydrogen peroxide and UV irradiation should be used for 24 h before it can be used again. The povidone-iodine or the chlorhexidine, could be recommended when there is a risk of SARS-CoV-2 contamination especially for open wounds. According to the different studies on SARS-CoV-2 disinfection, because of the SARS-CoV-2 can remain in the air and on surfaces, as well as observing individual disinfection guidelines in different hospital areas, disinfection of surfaces is necessary to decrease SARS-CoV-2 spreading. Moreover, the most suggested disinfectants have been limited to bleach and alcohol, it's better to be considered the potential of other disinfectants in different areas.

Influence of the COVID-19 pandemic on contact lens wear in Spain

PURPOSE

To investigate the behaviour of contact lens (CL) wearers in Spain during the COVID-19 pandemic.

METHODS

An anonymized web-based questionnaire was used to assess demographics, CL history, and activity, CL wear habits and perceived risk of infection due to CL wear during the COVID-19 pandemic.

RESULTS

A total of 737 participants with an average age of 27.4 (±9.3) years completed the online questionnaire. The vast majority of respondents were soft CL wearers and reported at least two years of CL wear. Patients concerns about the increased risk of SARS-CoV-2 infection due to CL wear (40.6 % of participants) were significantly related (χ2(1) = 11.195, p < 0.05) to CL discontinuation (46 % of participants) during the COVID-19 pandemic. This fact joins the significant changes in the frequency of CL wear during the COVID-19 pandemic (χ2(4) = 31.982, p < 0.05), with a tendency to increase occasional CL wear from 29.1 % to 61.8 %. Interestingly, the majority of respondent (87.9 %) indicated that no professional had offered them information related to CL wear and COVID-19, and that they had not sought it on their own (82.2 %).

CONCLUSION

There is a relationship between the perceived risk of infection and CL dropout during the COVID-19 pandemic, and a tendency to change the CL frequency of wear, with an increase in occasional CL wear. During the ongoing pandemic, eye care practitioners should reinforce CL patient education to minimize the risk of SARS-CoV-2 infection and CL-related complications requiring clinical care.

Effects of the COVID-19 Pandemic on Turkish Ophthalmologists

Objectives:

To assess the effects of the coronavirus disease-2019 (COVID-19) pandemic on Turkish ophthalmologists.

Materials and Methods:

In this survey study, an online questionnaire consisting of 40 questions was directed to actively working ophthalmologists. The questions asked about demographic characteristics, working conditions and schedule, follow-up of ophthalmology patients, and levels of knowledge and anxiety about the pandemic.

Results:

This study included 161 ophthalmologists (78 women and 83 men). They were predominantly consultant ophthalmologists (71%), with 128 living in metropolitan areas. More than half (54.4%) reported decreased weekly working hours, 52.5% were attending routine outpatient clinics, 52.8% were working in COVID-19-related units, 67.1% were performing only emergency operations, and 52% reported disrupted follow-up of chronic eye patients. Sixty-four percent thought that ophthalmologists were in the high-risk group, and nearly all participants used masks while working (99%). Additionally, 91% expressed high anxiety regarding the pandemic, most commonly due to the risk of transmitting the disease to family (83%), and 12.5% considered their level of knowledge about the pandemic to be insufficient. Forty-six percent of the participants thought that daily life conditions would normalize in 2 to 5 months.

Conclusion:

Close proximity during patient examination causes ophthalmologists concern about their risk. The increasing number of COVID-19 cases resulted in a proportional decrease in the number of patients and surgeries in ophthalmology clinics in our country. As a result, ophthalmologists are unwillingly appointed to high-risk units. The COVID-19 pandemic has caused a substantial increase in anxiety levels among Turkish ophthalmologists.

Generation and Characterization of recombinant SARS-CoV-2 expressing reporter genes

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen responsible of coronavirus disease 2019 (COVID-19), has devastated public health services and economies worldwide. Despite global efforts to contain the COVID-19 pandemic, SARS-CoV-2 is now found in over 200 countries and has caused an upward death toll of over 1 million human lives as of November 2020. To date, only one Food and Drug Administration (FDA)-approved therapeutic drug (Remdesivir) and a monoclonal antibody, MAb (Bamlanivimab) are available for the treatment of SARS-CoV-2. As with other viruses, studying SARS-CoV-2 requires the use of secondary approaches to detect the presence of the virus in infected cells. To overcome this limitation, we have generated replication-competent recombinant (r)SARS-CoV-2 expressing fluorescent (Venus or mCherry) or bioluminescent (Nluc) reporter genes. Vero E6 cells infected with reporter-expressing rSARS-CoV-2 can be easily detected via fluorescence or luciferase expression and display a good correlation between reporter gene expression and viral replication. Moreover, rSARS-CoV-2 expressing reporter genes have comparable plaque sizes and growth kinetics to those of wild-type virus, rSARS-CoV-2/WT. We used these reporter-expressing rSARS-CoV-2 to demonstrate their feasibility to identify neutralizing antibodies (NAbs) or antiviral drugs. Our results demonstrate that reporter-expressing rSARS-CoV-2 represent an excellent option to identify therapeutics for the treatment of SARS-CoV-2, where reporter gene expression can be used as valid surrogates to track viral infection. Moreover, the ability to manipulate the viral genome opens the feasibility of generating viruses expressing foreign genes for their use as vaccines for the treatment of SARS-CoV-2 infection.IMPORTANCE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen that causes coronavirus disease 2019 (COVID-19), has significantly impacted the human health and economic status worldwide. There is an urgent need to identify effective prophylactics and therapeutics for the treatment of SARS-CoV-2 infection and associated COVID-19 disease. The use of fluorescent- or luciferase-expressing reporter expressing viruses has significantly advanced viral research. Here, we generated recombinant (r)SARS-CoV-2 expressing fluorescent (Venus and mCherry) or luciferase (Nluc) reporter genes and demonstrate that they represent an excellent option to track viral infections in vitro. Importantly, reporter-expressing rSARS-CoV-2 display similar growth kinetics and plaque phenotype that their wild-type counterpart (rSARS-CoV-2/WT), demonstrating their feasibility to identify drugs and/or neutralizing antibodies (NAbs) for the therapeutic treatment of SARS-CoV-2. Henceforth, these reporter-expressing rSARS-CoV-2 can be used to interrogate large libraries of compounds and/or monoclonal antibodies (MAb), in high-throughput screening settings, to identify those with therapeutic potential against SARS-CoV-2.

The impact of patient behaviour and care system compliance on reusable soft contact lens complications

Reusable soft daily wear contact lenses (CLs) remain popular and were fit to just over half of all wearers in the most recent international CL prescribing survey. Unlike daily disposable CLs, reusables require cleaning and disinfecting after every use, along with storage in a CL case. These additional requirements add a number of steps to the daily wear and care routine, increasing the opportunities for CL wearers to exhibit non-compliant behaviour. The impact of non-compliance ranges from poor lens comfort through to potentially sight-threatening infective keratitis. The coronavirus pandemic has refocused the profession on the importance of hand hygiene in particular, and the need for promoting safe CL wear in general. This review summarises typical non-compliant behaviour related to reusable CLs, and examines strategies and opportunities to better support wearers. Patient education has a central role in encouraging compliant behaviour, although patient recall of information is low, and personal belief systems may result in continuation of non-compliant behaviour despite awareness of the risks. CL care solutions are required for the daily disinfection of lenses, however misuse of multipurpose solutions (MPS) and hydrogen peroxide (H₂O₂)-based care systems can challenge their ability to be fully efficacious. Standard efficacy testing is reviewed, with consideration of how well current protocols model real-world use of CL solutions. Although some recommendations are in place for the inclusion of additional variables such as lens cases, CL materials, organic soil and efficacy against Acanthamoeba, opportunity still exists to reevaluate global standards to ensure consistency of testing in all markets. Finally, potential future innovations are discussed which may further support increased safety in reusable lens wear through novel antimicrobial additions to both CL materials and cases.

Patient - practitioner communication and contact lens compliance during a prolonged COVID-19 lockdown

Purpose

Ocular manifestations and ocular transmission of SARS-CoV-2 in contact lens (CL) wearers may be fostered by non-compliance with care and maintenance instructions which, in turn, may be aggravated by inadequate patient-practitioner communication. The purpose of this research was to determine CL use, compliance and patient-practitioner communication during a 3-month long COVID-19 lockdown in Spain.

Methods

An online survey (developed using Google Forms) retrospectively evaluated CL compliance during the 3-month lockdown (responses captured between 15th July and 10th August, 2020), with particular emphasis on patient-practitioner communication, handwashing practices and CL case hygiene and replacement.

Results

A total of 247 responses were collected and analysed. Most participants used monthly replacement soft lenses (64.8 %) and multipurpose solutions (75.7 %), with 86.6 % of them owning a storage case for their lenses. During lockdown, a significant percentage of participants ceased lens wear (28.4 %) or reduced wearing time (49.2 %). Regarding patient-practitioner communication, 54.3 % of respondents received specific instructions, mostly about handwashing (93.3 %) and storage case hygiene (48.5 %). The most frequent non-compliant practices were inadequate handwashing (36.4 %), and overextending monthly or two-weekly replacement lenses (35.2 %). Many respondents never cleaned (23.0 %) nor replaced (16.3 %) their storage case, and 27.8 % of them reported not having been informed about case hygiene by their practitioners.

Conclusion

Contact lens compliance, particularly in terms of handwashing and storage case hygiene, was poor during a prolonged COVID-19 lockdown, thus stressing the need to foster patient-practitioner communication strategies to curtail the possibility of ocular transmission and the risk of virus tropism.

Assessment of contact lens wearers' attitude toward contact lens wear and care during Coronavirus Disease 2019 (COVID-19) pandemic: A cross-sectional online survey

AIM

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several reports have provided conflicting recommendations regarding contact lenses (CL) use during COVID-19, causing confusion among CL wearers. The aim of this study is to assess CL wearers' attitudes toward CL wear and care during COVID-19 pandemic.

METHODS

A web-based cross-sectional online survey was used to assess the participants' attitude toward CL wear and care during the COVID-19 pandemic. The survey layout was based on Google form® specifically developed for CL wearers. Demographic characteristics and CL history and profile were also collected for each participant.

RESULTS

A total of 196 CL wearers completed the online survey with an average age was 26 (± 4.1) and 90.8 % of participants were females. As reported by the participants, social media was the main source of information about COVID-19. 38.8 % of the study population reported stopping CL wear during the pandemic. The main stated reason for lens discontinuation was decreased social activities during the pandemic. 61.2 % of participants continued lens wear, with the majority reported considerable changes in their behaviors toward CL wear and care during the pandemic. This includes reinforced hands cleaning before and after lens wear, disinfecting of CLs and CL case and less frequent CL aftercare visits.

CONCLUSION

The majority of the study population have continued CL wear during the pandemic. Contact lens wearers reported profound changes in attitudes toward CL wear including improved care and maintenance. Additionally, changes in CL purchase habit have been reported with more tendency for online purchase. CL cessation has been associated with several perceived reasons mainly attributed to reduced outdoor activity and fear of ocular infection. Levels of compliance among CL wearers should be assessed and reinforced during the current pandemic and similar lockdown situation to reduce possible CL-related complications and dropout.

Clinical guidelines for the management of keratoconus patients with gas permeable contact lenses based on expert consensus and available evidence

PURPOSE OF REVIEW

Fitting rigid gas permeable contact lenses (RGP CLs) in keratoconic patients is the most common visual rehabilitation option to improve patients' quality of life, but require long patient and practitioner chair time. The purpose of this review is to provide evidence-based clinical practice guidelines (CPG) in the management of patients with keratoconus with RGP CLs.

RECENT FINDINGS

An extensive literature review from 1990 to 2017 identified 354 potentially relevant publications. Fifty-two articles were reviewed and included in the CPG. An international expert panel of eight contact lens practitioners, with vast experience in keratoconus management reviewed and appraised the CPG following the Appraisal of Guidelines for Research and Evaluation II consortium requirements. The developed CPG clearly outlines a strategy for the successful fitting of RGP CLs in patients with keratoconus. This includes how to calculate parameters of the first diagnostic lens, criteria for assessing good fit and a standardized schedule of wear time and follow-up appointments.

SUMMARY

The current evidence and consensus-based CPG helps guide clinicians in a successful strategy for fitting RGP CLs in patients with keratoconus.

Surface interactions and viability of coronaviruses

The recently emerged coronavirus pandemic (COVID-19) has become a worldwide threat affecting millions of people, causing respiratory system related problems that can end up with extremely serious consequences. As the infection rate rises significantly and this is followed by a dramatic increase in mortality, the whole world is struggling to accommodate change and is trying to adapt to new conditions. While a significant amount of effort is focused on developing a vaccine in order to make a game-changing anti-COVID-19 breakthrough, novel coronavirus (SARS-CoV-2) is also developing mutations rapidly as it transmits just like any other virus and there is always a substantial chance of the invented antibodies becoming ineffective as a function of time, thus failing to inhibit virus-to-cell binding efficiency as the spiked protein keeps evolving. Hence, controlling the transmission of the virus is crucial. Therefore, this review summarizes the viability of coronaviruses on inanimate surfaces under different conditions while addressing the current state of known chemical disinfectants for deactivation of the coronaviruses. The review attempts to bring together a wide spectrum of surface-virus-cleaning agent interactions to help identify material selection for inanimate surfaces that have frequent human contact and cleaning procedures for effective prevention of COVID-19 transmission.

Contact lens wear and care in Spain during the COVID-19 pandemic

AIM

To establish contact lens wear and care practices during the COVID-19 pandemic in Spain.

METHOD

A 58-item anonymous online survey was distributed during the period 30th April to 10th May via Qualtrics. The survey explored: a) demographic characteristics (age, sex, general health and where they were living during lockdown), b) changes in their contact lens use during lockdown, c) hygiene and contact lens compliance and d) concerns associated with contact lens wear and ways to support wearers during the pandemic.

RESULTS

Two hundred and sixty responses were analysed (38.8 ± 11.4 years old, 75% female). Three-quarters of participants reported that they were self-isolating or rigorously following social distancing advice. Sixty-seven percent of participants reported using their contact lenses less during the pandemic. Respondents were found to be compliant with handwashing prior to inserting and removing contact lenses (in both cases 97% doing this 'most times' or 'every time'). However, only 44 % complied with the '20 s rule' and 48 % used a shared towel to dry their hands. A higher proportion of hydrogen peroxide users replaced the lens case monthly compared to multi-purpose users (64% vs.49%; p < 0.001). Twenty-four percent admitted wearing lenses whilst showering and 16% did not consider ceasing lens wear if feeling unwell with flu/cold symptoms.

CONCLUSION

Eye care practitioners should continue to educate contact lens wearers to ensure safe contact lens wear to minimise the chance of developing contact lens related complications during the pandemic. Modifiable factors that need particular attention in Spain include: handwashing for at least 20s before lens handling, drying hands with single use paper towels, including a rub-and-rinse step for reusable lenses, lens case cleaning and renewal, avoidance of water exposure and when to cease lens wear during the pandemic.

Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Purpose

This study was performed to determine the occurrence of ocular surface manifestations in patients diagnosed with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods

A systematic search of electronic databases i.e. PubMed, Web of Science, CINAHL, OVID and Google scholar was performed using a comprehensive search strategy. The searches were current through 31st May 2020. Pooled data from cross-sectional studies was used for meta-analysis and a narrative synthesis was conducted for studies where a meta-analysis was not feasible.

Results

A total of 16 studies reporting 2347 confirmed COVID-19 cases were included. Pooled data showed that 11.64% of COVID-19 patients had ocular surface manifestations. Ocular pain (31.2%), discharge (19.2%), redness (10.8%), and follicular conjunctivitis (7.7%) were the main features. 6.9% patients with ocular manifestations had severe pneumonia. Viral RNA was detected from the ocular specimens in 3.5% patients.

Conclusion

The most common reported ocular presentations of COVID-19 included ocular pain, redness, discharge, and follicular conjunctivitis. A small proportion of patients had viral RNA in their conjunctival/tear samples. The available studies show significant publication bias and heterogeneity. Prospective studies with methodical collection and data reporting are needed for evaluation of ocular involvement in COVID-19.

Risk factors associated with morbidity and mortality outcomes of COVID-19 patients on the 28th day of the disease course: a retrospective cohort study in Bangladesh

Diverse risk factors intercede the outcomes of coronavirus disease 2019 (COVID-19). We conducted this retrospective cohort study with a cohort of 1016 COVID-19 patients diagnosed in May 2020 to identify the risk factors associated with morbidity and mortality outcomes. Data were collected by telephone-interview and reviewing records using a questionnaire and checklist. The study identified morbidity and mortality risk factors on the 28th day of the disease course. The majority of the patients were male (64.1%) and belonged to the age group 25-39 years (39.4%). Urban patients were higher in proportion than rural (69.3% vs. 30.7%). Major comorbidities included 35.0% diabetes mellitus (DM), 28.4% hypertension (HTN), 16.6% chronic obstructive pulmonary disease (COPD), and 7.8% coronary heart disease (CHD). The morbidity rate (not-cured) was 6.0%, and the mortality rate (non-survivor) was 2.5%. Morbidity risk factors included elderly (AOR = 2.56, 95% CI = 1.31-4.99), having comorbidity (AOR = 1.43, 95% CI = 0.83-2.47), and smokeless tobacco use (AOR = 2.17, 95% CI = 0.84-5.61). The morbidity risk was higher with COPD (RR = 2.68), chronic kidney disease (CKD) (RR = 3.33) and chronic liver disease (CLD) (RR = 3.99). Mortality risk factors included elderly (AOR = 7.56, 95% CI = 3.19-17.92), having comorbidity (AOR = 5.27, 95% CI = 1.88-14.79) and SLT use (AOR = 1.93, 95% CI = 0.50-7.46). The mortality risk was higher with COPD (RR = 7.30), DM (RR = 2.63), CHD (RR = 4.65), HTN (RR = 3.38), CKD (RR = 9.03), CLD (RR = 10.52) and malignant diseases (RR = 9.73). We must espouse programme interventions considering the morbidity and mortality risk factors to condense the aggressive outcomes of COVID-19.

Risk factors associated with morbidity and mortality outcomes of COVID-19 patients on the 28th day of the disease course: a retrospective cohort study in Bangladesh

Diverse risk factors intercede the outcomes of coronavirus disease 2019 (COVID-19). We conducted this retrospective cohort study with a cohort of 1016 COVID-19 patients diagnosed in May 2020 to identify the risk factors associated with morbidity and mortality outcomes. Data were collected by telephone-interview and reviewing records using a questionnaire and checklist. The study identified morbidity and mortality risk factors on the 28th day of the disease course. The majority of the patients were male (64.1%) and belonged to the age group 25-39 years (39.4%). Urban patients were higher in proportion than rural (69.3% vs. 30.7%). Major comorbidities included 35.0% diabetes mellitus (DM), 28.4% hypertension (HTN), 16.6% chronic obstructive pulmonary disease (COPD), and 7.8% coronary heart disease (CHD). The morbidity rate (not-cured) was 6.0%, and the mortality rate (non-survivor) was 2.5%. Morbidity risk factors included elderly (AOR = 2.56, 95% CI = 1.31-4.99), having comorbidity (AOR = 1.43, 95% CI = 0.83-2.47), and smokeless tobacco use (AOR = 2.17, 95% CI = 0.84-5.61). The morbidity risk was higher with COPD (RR = 2.68), chronic kidney disease (CKD) (RR = 3.33) and chronic liver disease (CLD) (RR = 3.99). Mortality risk factors included elderly (AOR = 7.56, 95% CI = 3.19-17.92), having comorbidity (AOR = 5.27, 95% CI = 1.88-14.79) and SLT use (AOR = 1.93, 95% CI = 0.50-7.46). The mortality risk was higher with COPD (RR = 7.30), DM (RR = 2.63), CHD (RR = 4.65), HTN (RR = 3.38), CKD (RR = 9.03), CLD (RR = 10.52) and malignant diseases (RR = 9.73). We must espouse programme interventions considering the morbidity and mortality risk factors to condense the aggressive outcomes of COVID-19.

An Ophthalmic Insight into Novel Coronavirus 2019 Disease: A Comprehensive Review of the Ocular Manifestations and Clinical Hazards

PURPOSE

To discuss the ocular manifestations provoked by novel coronavirus 2019 (COVID-19) disease in humans, the natural history of the disease in the eye, and its treatment.

METHODS

We designed a narrative review of the ocular manifestations of COVID-19 based on the literature published till July 30, 2020. The databases were PubMed, Scopus, Cochrane Library, Google Scholar, and ScienceDirect. The inclusion criteria were (1) all types of clinical studies and (2) the topic was COVID-19 and its association to the eye regarding the current guidelines.

RESULTS

From 168 abstracts screened, 61 papers fully filled the inclusion criteria after the full-text screening. The 61 records include 13 case reports, 17 prospective (case series or cross-sectional) studies, 8 retrospective studies, 12 literature reviews (one systematic review), and 11 letters to the editor. The majority of the papers agreed that ophthalmic manifestations due to COVID-19 were few and rarely encountered. The main ocular pathology seemed to be conjunctivitis, where the viral polymerase chain reaction also happened to be most detectable. Posterior segment or neuro-ophthalmic manifestations were scarce. Viral genome detection in the eye as well as viral portal of entry to the globe is still vague.

CONCLUSION

The exact incidence of ocular manifestations in COVID-19 disease is uncertain. Conjunctivitis is the most prevalent ocular manifestation. It is still a debate whether the eye is a portal of entry for infection.

Rescue of SARS-CoV-2 from a Single Bacterial Artificial Chromosome

The pandemic coronavirus (CoV) disease 2019 (COVID-19) caused by severe acute respiratory syndrome CoV-2 (SARS-CoV-2) is a major threat to global human health. To date, there are no approved prophylactics or therapeutics available for COVID-19. Reverse genetics is a powerful approach to understand factors involved in viral pathogenesis, antiviral screening, and vaccine development. In this study, we describe the feasibility of generating recombinant SARS-CoV-2 (rSARS-CoV-2) by transfection of a single bacterial artificial chromosome (BAC). Importantly, rSARS-CoV-2 possesses the same phenotype as the natural isolate in vitro and in vivo. This is the first description of a BAC-based reverse genetics system for SARS-CoV-2 and the first time that an rSARS-CoV-2 isolate has been shown to be phenotypically identical to a natural isolate in a validated animal model of SARS-CoV-2 infection. The BAC-based reverse genetics approach will facilitate the study of SARS-CoV-2 and the development of prophylactics and therapeutics for the treatment of COVID-19.

Infectious coronavirus (CoV) disease 2019 (COVID-19) emerged in the city of Wuhan (China) in December 2019, causing a pandemic that has dramatically impacted public health and socioeconomic activities worldwide. A previously unknown coronavirus, severe acute respiratory syndrome CoV-2 (SARS-CoV-2), has been identified as the causative agent of COVID-19. To date, there are no U.S. Food and Drug Administration (FDA)-approved vaccines or therapeutics available for the prevention or treatment of SARS-CoV-2 infection and/or associated COVID-19 disease, which has triggered a large influx of scientific efforts to develop countermeasures to control SARS-CoV-2 spread. To contribute to these efforts, we have developed an infectious cDNA clone of the SARS-CoV-2 USA-WA1/2020 strain based on the use of a bacterial artificial chromosome (BAC). Recombinant SARS-CoV-2 (rSARS-CoV-2) was readily rescued by transfection of the BAC into Vero E6 cells. Importantly, BAC-derived rSARS-CoV-2 exhibited growth properties and plaque sizes in cultured cells comparable to those of the natural SARS-CoV-2 isolate. Likewise, rSARS-CoV-2 showed levels of replication similar to those of the natural isolate in nasal turbinates and lungs of infected golden Syrian hamsters. This is, to our knowledge, the first BAC-based reverse genetics system for the generation of infectious rSARS-CoV-2 that displays features in vivo similar to those of a natural viral isolate. This SARS-CoV-2 BAC-based reverse genetics will facilitate studies addressing several important questions in the biology of SARS-CoV-2, as well as the identification of antivirals and development of vaccines for the treatment of SARS-CoV-2 infection and associated COVID-19 disease.

COVID-19 and ocular implications: an update

BACKGROUND

COronaVIrus Disease 19 (COVID-19) was first reported in Wuhan, China in December 2019 and is now pandemic all over the world. The purpose of this review is to highlight the possible ocular presentation of COVID-19 infection and the consequence of the pandemic in the daily ophthalmology routine. A total of 9 articles was included by searching PubMed database for articles published between December 2019 and April 2020.

MAIN BODY

Conjunctivitis (and keratoconjunctivitis) can be the first symptom in infected patients. The virus can be present in tear and conjunctival secretions, requiring maximum attention. It's important to understand if COVID-19 could spread through the ocular route or present as the primary infected site. Ocular implications should also be considered for therapy. In fact, one potential treatment is chloroquine and its derivatives, including hydroxychloroquine. Hydroxychloroquine, in fact, can induced retinal toxicity. The exponential increase in lthe number of Covid-19 cases was like a tsunami for health care companies, which were not ready to face this emergency. Ophthalmology departments were also affected by the reorganization of healthcare services.

CONCLUSION

The studies analaysed have some limitations. First, the sample size and the covered population consisted mainly of patients with mild disease. Moreover, the studies are often descriptive study, without a correlation analysis. Finally, no normal population was observed in the studies, so a normal control group should be included for comparison in future studies. With the evolving COVID-19 pandemic and with its high infectivity, it is necessary to rearrange ophthalmologist routine clinical practice in order to control viral spread and try to maximize patient and health-care provider's safety.

In pursuit of COVID-19 surgical risk stratification to manage a limited workforce and supplies in minimally invasive surgery

The protective barriers used so far in surgery do not provide adequate protection against SARS-CoV-2 virus, and reinforced protective equipment is needed. The rapid increase in the number of patients and the worldwide panic associated with the increasingly low availability of protective equipment has resulted in a shortage of protective equipment in many hospitals. Appropriatepersonal protective equipment must be provided so that the surgical team proceeding to surgery is not excluded from the further struggle for patients' health, especially in MIS. Reckless and excessive use of maximum protective equipment may result in a severe shortage of these products when the number of infected persons requiring surgery increases. The use of a structured infection risk scheme for medical staff, depending on the results of reverse transcription polymerase chain reaction assays and COVID-19 symptoms, combined with the division of protection equipment into three groups, allows easy selection of an appropriate clothing scheme for the clinical setting.

Soft contact lens wearers' compliance during the COVID-19 pandemic

Aim

Contact lens wearers need to maintain optimal hygiene practices during the COVID-19 pandemic to minimise contact-lens complications including microbial keratitis and corneal infiltrative events. This online survey (UK and Ireland) explored contact lens wearers’ compliance behaviours, attitudes and concerns during the pandemic.

Method

The 60-item anonymous online survey was distributed during a 1-month period via Qualtrics (starting on 14/04/20). The survey captured: a) demographic information, b) type of lenses worn and compliance with lens wear and care procedures, c) adherence to recommendations and d) concerns associated with contact lens wear during the pandemic.

Results

Two hundred and forty seven responses were received (34.3 ± 11.7 years old, 79% female). Seventy nine percent of participants reported that they were self-isolating or rigorously following social distance advice. Fifty-six percent of participants reported using their lenses less during the pandemic. Eighty-seven percent of respondents reported following the recommended 20-second rule most times/every time and 96% used soap and water during handwashing. Eleven percent of respondents admitted not following recommendations regarding disposal of lenses and 18% would not consider ceasing lens wear if unwell (with flu/cold) during the pandemic.

Conclusion

Respondents reported wearing their contact lenses less than usual. Good compliance with handwashing was observed but soft reusable lens wearers showed a statistically significant lower compliance with lens wear and care compared to daily disposable lens wearers (p=<0.001).

COVID-19 guidelines for optometry and optical services post-lockdown

The COVID-19 pandemic has caused disruption in everyone's lives globally. Optometrists, being primary health care professionals are at a higher risk of infection in their practices during these testing times. Optometrists and optical store owners need practically implementable guidelines as lockdown gets lifted in various parts of our country. As these practices gear up to provide eye examination and vision correction to people, they need to take necessary precautions to avoid any cross contaminations. Optometry Council of India guidelines were circulated among optometry and optical associations and among experts in various optometry specialty. A consensus among various bodies were arrived. These guidelines provide recommendation for optical and optometry practices.

Rescue of SARS-CoV-2 from a single bacterial artificial chromosome

An infectious coronavirus disease 2019 (COVID-19) emerged in the city of Wuhan (China) in December 2019, causing a pandemic that has dramatically impacted public health and socioeconomic activities worldwide. A previously unknown coronavirus, Severe Acute Respiratory Syndrome CoV-2 (SARS-CoV-2), has been identified as the causative agent of COVID-19. To date, there are no United States (US) Food and Drug Administration (FDA)-approved vaccines or therapeutics available for the prevention or treatment of SARS-CoV-2 infection and/or associated COVID-19 disease, which has triggered a large influx of scientific efforts to develop countermeasures to control SARS-CoV-2 spread. To contribute to these efforts, we have developed an infectious cDNA clone of the SARS-CoV-2 USA-WA1/2020 strain based on the use of a bacterial artificial chromosome (BAC). Recombinant (r)SARS-CoV-2 was readily rescued by transfection of the BAC into Vero E6 cells. Importantly, the BAC-derived rSARS-CoV-2 exhibited growth properties and plaque sizes in cultured cells comparable to those of the SARS-CoV-2 natural isolate. Likewise, rSARS-CoV-2 showed similar levels of replication to that of the natural isolate in nasal turbinates and lungs of infected golden Syrian hamsters. This is, to our knowledge, the first BAC based reverse genetics system for the generation of infectious rSARS-CoV-2 that displays similar features in vivo to that of a natural viral isolate. This SARS-CoV-2 BAC-based reverse genetics will facilitate studies addressing several important questions in the biology of SARS-CoV-2, as well as the identification of antivirals and development of vaccines for the treatment of SARS-CoV-2 infection and associated COVID-19 disease.

Assessment of Knowledge, Practice and Guidelines towards the Novel COVID-19 among Eye Care Practitioners in Nigeria-A Survey-Based Study

The aim of this study was to explore knowledge, practice of risk and guidelines of the novel corona virus disease (COVID-19) infection among the eye care practitioners and the potential associated factors. A cross-sectional self-administered online survey was distributed via emails and social media networks between 2nd and 18th May 2020 corresponding to the week of the lockdown in Nigeria to eye care practitioners (ECPs). Data for 823 respondents were analyzed. Knowledge and risk practice were categorized as binary outcome and univariate and multivariate linear regression were used to examine the associated factors. The mean score for COVID-19-related knowledge of public health guidelines was high and varied across the ECPs. Ophthalmic Nurses, Ophthalmologists and Optometrists showed higher COVID-19-related knowledge than other ECPs (p < 0.001), particularly those working in the private sector. More than 50% of ECPs stated they provided essential services during the COVID-19 lockdown via physical consultation, particularly the Ophthalmologists. Most respondents reported that the guidelines provided by their Association were useful but expressed their lack of confidence in attending to patients during and after the COVID-19 lockdown. Compared to other ECPs in Nigeria, more Ophthalmic Nurses received training in the use of Personal Protective Equipment (PPE). This survey is the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Nigeria. ECPs in Nigeria displayed good knowledge about COVID-19 and provided eye care services during the COVID-19 lockdown in Nigeria, despite the majority not receiving any training on the use of PPEs with concerns over attending to patients. There is need for the government to strengthen health systems by improving and extending training on standard infection prevention and control measures to ECPs for effective control of the pandemic and in the future as essential health workers.

The ocular surface, coronaviruses and COVID-19

The ocular surface has been suggested as a site of infection with Coronavirus-2 (SARS-CoV-2) responsible for the coronavirus disease-19 (COVID-19). This review examines the evidence for this hypothesis, and its implications for clinical practice. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), responsible for the COVID-19 pandemic, is transmitted by person-to-person contact, via airborne droplets, or through contact with contaminated surfaces. SARS-CoV-2 binds to angiotensin converting enzyme-2 (ACE2) to facilitate infection in humans. This review sets out to evaluate evidence for the ocular surface as a route of infection. A literature search in this area was conducted on 15 April 2020 using the Scopus database. In total, 287 results were returned and reviewed. There is preliminary evidence for ACE2 expression on corneal and conjunctival cells, but most of the other receptors to which coronaviruses bind appear to be found under epithelia of the ocular surface. Evidence from animal studies is limited, with a single study suggesting viral particles on the eye can travel to the lung, resulting in very mild infection. Coronavirus infection is rarely associated with conjunctivitis, with occasional cases reported in patients with confirmed COVID-19, along with isolated cases of conjunctivitis as a presenting sign. Coronaviruses have been rarely isolated from tears or conjunctival swabs. The evidence suggests coronaviruses are unlikely to bind to ocular surface cells to initiate infection. Additionally, hypotheses that the virus could travel from the nasopharynx or through the conjunctival capillaries to the ocular surface during infection are probably incorrect. Conjunctivitis and isolation of the virus from the ocular surface occur only rarely, and overwhelmingly in patients with confirmed COVID-19. Necessary precautions to prevent person-to-person transmission should be employed in clinical practice throughout the pandemic, and patients should be reminded to maintain good hygiene practices.