Precautions in ophthalmic practice in a hospital with the risk of COVID-19: experience from China

Prevalence of SARS-CoV-2 amongst ophthalmologists throughout the first and second waves of the pandemic

The study aims to investigate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among ophthalmology unit staff throughout the first and second waves of the outbreak, in order to verify the effectiveness of the measures adopted in containing the contagion.A retrospective observational study was conducted involving staff members, who received a naso/oropharyngeal swab when complaining of SARS-CoV-2 symptoms and once a month as a screening measure. They were tested for SARS-CoV-2 antibodies as a screening measure during the first and the second wave. Clinical activities performed during the outbreak were compared with those performed during the same period in 2019 and correlated with the number of coronavirus disease-2019 eye care workers.Analysis included 25 workers. Clinical infection was 0% and 12% whereas the prevalence of SARS-CoV-2 antibodies ranged from 4% to 8% in the first and second wave, respectively. The increase in the prevalence of SARS-CoV-2 infection between the first and the second wave was not significant (1/25 vs 3/25, P = .6092). Clinical activities significantly decreased during the first wave compared with the same period in 2019 (3256 vs 10,075, P < .0001, -68% to 2019), but increased during the second wave (8208 vs 3256, P < .0001, +152% to the first wave).Despite the increase in routine activities during the second wave, we did not observe a significant increase in SARS-CoV-2 prevalence. Strict protection measures seemed to contain the rate of contagion among the ophthalmology unit members even in a high-volume clinical setting in one of the most affected area by the coronavirus disease-2019 outbreak.

Telemedicine comes of age during coronavirus disease 2019 (COVID-19): An international survey of oculoplastic surgeons

PURPOSE

The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing healthcare crisis that continues its worldwide spread. Ophthalmologists are at high risk of acquiring and transmitting the virus. Telemedicine platforms have evolved and may play an important role in attenuating this risk. For patients, these platforms provide the possibility of clinic consultation without the concerns of a clinic visit. We aimed to assess the utilization of telemedicine by oculoplastics specialists worldwide during the COVID-19 pandemic.

METHODS

A 13-item survey was distributed internationally to practicing oculoplastic surgeons. Collected data included demographics, clinical practice variables and perceptions regarding telemedicine. Significance of associations and single survey items was evaluated by Chi-squared and z-score of proportions tests, respectively.

RESULTS

The questionnaire was completed by 70 oculoplastic surgeons (54.3% male, mean age 47.3 years, median experience 10 years) from eight countries, practicing in various clinical settings (50.0% hospitals, 45.7% private clinics, 4.3% community clinics). Most respondents reported telemedicine to be an effective tool for oculoplastic consultations (67.1%, p = 0.004), while only 12.8% (p < 0.00001) had incorporated this modality into clinical practice prior to the pandemic. Even though a vast majority (98.6%) of participants had limited outpatient activity, most (55.7%) felt unprotected from the virus. Telemedicine had been incorporated by 70.5% (p = 0.001) of respondents during the COVID-19 pandemic, whereas most (57.1%) predicted continued use of the modality.

CONCLUSION

Telemedicine can be effectively and rapidly incorporated into the clinical practice of oculoplastic surgeons during the COVID-19 pandemic. Further research into the most effective utilization of these platforms appears warranted.

Clinical operational considerations and responses to lockdown and reopening in the Covid-19 pandemic: experience of a tertiary ophthalmology centre in Singapore

Background

Much has been written on infection control and clinical measures for ophthalmic institutions and departments to cope with the COVID-19 pandemic. However, few articles have detailed implementation plans to manage lockdowns and subsequent re-openings. In this article, specific operational responses and their outcomes in a large tertiary ophthalmology centre are described.

Method

Through a concerted effort led by a dedicated task force, the Singapore National Eye Centre (SNEC) planned and executed an operational transformation to respond to the restrictions imposed on healthcare delivery during a national lock down. A carefully calibrated re-starting of services was carried out with the subsequent phased reopening of the country, taking into consideration unique constraints faced at that time. Strategies for operating in the new normal environment were also developed.

Results

Outpatient attendances were safely and expediently reduced by 70% (8749 vs. 29,311) and 82% (5164 vs. 29,342) in April and May 2020, respectively, compared to the corresponding months in 2019. A correspondingly large reduction in surgical load was also achieved through a similar triaging and prioritization system. Through optimizing the center’s use of space and time, as well as expanding on new models of care, a return to pre-pandemic patient load was achieved 3 months into the phased reopening of the country, and subsequently exceeded in the following months.

Conclusion

The lessons gleaned from SNEC’s experience may be useful for institutions currently facing the same challenges, and for future responses to COVID-19 resurgences or other pandemics.

Characteristics and Developments in Mesenchymal Stem Cell Therapy for COVID-19: An Update

The outbreak of coronavirus disease 2019 (COVID-19) has so far resulted in over a hundred million people being infected. COVID-19 poses a threat to human health around the world. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been confirmed as the pathogenic virus of COVID-19. SARS-CoV-2 belongs to the β-coronavirus family of viruses and is mainly transmitted through the respiratory tract. It has been proven that SARS-CoV-2 mainly targets angiotensin-converting enzyme II (ACE2) receptors on the surface of various cells in humans. The main clinical symptoms of COVID-19 include fever, cough, and severe acute respiratory distress syndrome (ARDS). Current evidence suggests that the damage caused by the virus may be closely related to the induction of cytokine storms in COVID-19. No specific drugs or measures have yet to be shown to cure COVID-19 completely. Cell-based approaches, primarily mesenchymal stem cells (MSCs), have been identified to have anti-inflammatory and immune functions in COVID-19. Clinical studies about using MSCs and its derivatives-exosomes for COVID-19 treatment-are under investigation. Here, we review the current progress of the biological characteristics, clinical manifestations, and cell-based treatment development for COVID-19. Providing up-to-date information on COVID-19 and potential MSC therapies will help highlight routes to prevent and treat the disease.

The Impact of COVID-19 on Intravitreal Injection Compliance

Intravitreal injections (IVI) of anti–vascular endothelial growth factor (anti–VEGF) agents have become the most prevalent intraocular procedure as they represent the major therapeutic modality for prevalent retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy. Effective therapy requires adherence to a schedule of iterative IVI as well as routine clinic appointments. The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in the reduction of attendance at scheduled clinic visits and IVI. In this study, we attempted to analyze the effect of COVID-19 on compliance with anti–VEGF therapy. A total of 636 eyes received injections during a 4-week period of the COVID-19 outbreak in the Retina Clinic. The number of clinic visits for IVI during 1 month from March 15 to April 14 of 2020 was compared to a similar time period in each of the last 4 years. The study demonstrates a decrease in clinic visits for IVI when compared with the same 4-week interval in the four previous years. Based on the trend of the previous 4 years, 10.2% of the year’s total was expected for this time period. Using this model, the 636 reported number of injections for the March–April 2020 period was ~ 5%. This represents a decrease of ~ 50% of the expected IVI for this time period. The COVID-19 outbreak in Israel severely impacted compliance with anti–VEGF treatments.

Intravitreal injections during COVID-19 outbreak: Real-world experience from an Italian tertiary referral center

We report our experience during COVID-19 outbreak for intravitreal injections in patients with maculopathy. We proposed a treatment priority levels and timings; the "High" priority level includes all monocular patients; the "Moderate" is assigned to all patients with an active macular neovascularization; the patients affected by diabetic macular edema or retinal vein occlusion belong to the "Low" class. This organization allowed us to treat the most urgent patients although the injections performed had a 91.7% drop compared to the same period of 2019.