A MESSAGE FROM THE ESCRS PRESIDENT
18 March 2020
Dear Colleagues Welcome to the European Society of Cataract and Refractive Surgeons’ second digital communication on the challenges COVID-19 are placing on our colleagues worldwide. We hope in future days to bring you news of strategies and coping mechanisms that are coming into play across Europe and across the world. Today we include in our communication the personal experience and recommendations of one of our colleagues, in this update, Lucio Buratto from Milan in Italy, the country that suffers the most at the moment from COVID-19. In future publications we will include information and guidance from other countries and jurisdictions. ESCRS, as a pan-European Society, is very aware
and alert to the fact that there are regulations, recommendations and guidance being offered by individual, national, European and international governments and professional societies. We do not intend any communications from us to either validate nor conflict with any local regulations or guidance. Please be aware that any information offered here is not an endorsement by ESCRS of any procedures or activities. Having said that, we would very much like to hear from you with any stories, suggestions or ideas, national recommendations and guidelines that you believe would be of benefit or interest to our community. Please send to COVID19@escrs.org We have created an ESCRS Coronavirus Library Archive where you will be able to download the information that is of interest for you. We will include in each issue of this newsletter the link to the excellent Johns Hopkins dashboard which keeps us up to date on the spread of this disease. View here As always, safe wishes to you and your families from the leadership of ESCRS.
Prof. dr Rudy MMA Nuijts
ESCRS President
NEW STUDIES SHOW CONJUNCTIVAL INVOLVEMENT IN COVID-19 INFECTED PATIENTS
Two new studies suggest that COVID-19 infections can cause conjunctivitis and that the initial infection may take an ocular route. The first study, published in The Journal of Medical Virology, was a prospective interventional case series study involving 30 confirmed novel coronavirus pneumonia (COVID-19) patients selected at the First Affiliated Hospital of Zhejiang University from 26 January 2020 to 9 February 2020. The second study, published in The New England Journal of Medicine, indicated that conjunctivitis may be an uncommon effect of viral infection. It involved a comprehensive review of symptoms, clinical findings and comorbidities 1099 patients with laboratory-confirmed Covid-19 from 52 hospitals in 30 provinces, autonomous regions, and
municipalities in mainland China through to January 29, 2020. It showed that conjunctival congestion was detected in nine (0.9%) patients.
PLEASE STERILISE AND AVOID CONTACT!
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, reports Dr Soosan Jacob from India. We have instructed doctors, residents, optometrists and staff to avoid these or use gloves. Patients are instructed to strictly not 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 chinrest of the slitlamp is wiped down with alcohol wipes after every patient.
ITALIAN OPHTHALMOLGISTS MUST FIGHT THE VIRUS AND STAY SAFE
In an interview with EuroTimes Dr Matteo Piovella, President of the Italian Society of Ophthalmology said that every public hospital in northern Italy is now concentrating on COVID-19 and no eye surgery is taking place. "The situation is critical.
In some of our public hospitals we do not have enough gel, masks, gloves and protective clothing but steps are being taken to improve this situation. We also need more respiratory machines. "We also do not have enough doctors and nurses to cope with COVID-19 and the hospitals are having to recruit from outside for extra staff. "Some eye surgery can take place in private ophthalmology clinics but the staff must have the proper protective equipment and they must make sure that there is a safe distance between patients. "As president of the SOI, I thank my colleagues for all of the work they have done to fight this virus and I hope that they will stay safe in the future."
OPHTHALMOLOGY IN ITALY IS CLOSED, SAYS FORMER ESCRS PRESIDENT
Distinguished Italian ophthalmologist and former ESCRS President Dr Roberto Bellucci says in the north of Italy, where he practices, ophthalmology is closed. “All the people are staying at home and there is little sign that the infection will subside.
All public hospitals are closed for ophthalmology because all of the available rooms are occupied by COVID-19 patients. Private ophthalmology is open only for emergencies and all cataract surgery has been closed. The President of the Italian Society of Ophthalmology Dr Matteo Piovella is sending messages to all of our members explaining the current situation. The problem is particularly bad for patients with macular degeneration who cannot receive their monthly injections. My message to my colleagues in ophthalmology is that everyone of us will have to decide what type of care should be carried out and we should find the courage to do surgery for
patients with retinal detachment, trauma and other emergencies," said Dr Bellucci.
GUIDELINES FOR ITALIAN OPHTHALMOLOGISTS ON COVID-19
Dr Lucio Buratto has a clinic in Milan, the current epicentre of the COVID-19 pandemic. Dr Buratto has created guidelines for protecting both staff and patients during the outbreak. EuroTimes Editor Sean Henahan spoke with Dr Lucio Buratto by phone.
Q: You created some extensive guidelines for use during the crisis? A: We created these guidelines for our own protection. We have been using these for the last four weeks. We haven’t seen any infected patients. We have forwarded these guidelines to the Italian Society of Ophthalmology and are making this information available online. Following our own guidelines means protecting ourselves with eye protection, gloves, masks, shielding and everything else we can do. We have staff cleaning the clinic throughout the day. We ask our staff to take their temperatures at home in the morning and the evening. We also have shielding in place between patients and staff in the waiting area. Telephone screening is a key part of the process. We screen all patients on the phone. We ask about red eye and symptoms of conjunctivitis, as well as fever and other symptoms. We don’t accept those patients who report symptoms. We send them directly to the hospital where they can be seen by qualified people. Q: What is your recommended policy on using tonometry and endoscopy? A: We do our best not to use any contact procedures with the patients. We have non-contact air-puff tonometry. We are not doing gonioscopy, but we can use other methods to view the anterior chamber. If we absolutely must use contact instruments, we sterilize these. Q: What about intravitreal injections? A: We have also stopped doing intravitreal injections. This is true everywhere in Italy. Centers that used to do a hundred injections a day have all stopped. The hospitals are refusing to do any injections because they don’t want people lingering in the waiting rooms. This is terrible for our patients with maculopathy. Many have been treated for years with intravitreal injections. We fear that stopping these will be very bad for their vision.
Practical advice – reduce droplet infection with DIY protective slit-lamp shield
Here is a simple method how to create a barrier to reduce the risk of droplet infection transmission between the patient and ophthalmologist made of A4 plastic folder supplied to EuroTimes by Dr Pavel Stodulka, Czech Republic.
Dr John Kanellopoulos, MD, Greece also shows how to make a universal slit-lamp and microscope shield for eye care professionals: ophthalmologists, optometrists. It will make very close-up encounters of examining patients safer for some of the direct droplet spread from talking, sneezing and or coughing.
Dr Soosan Jacob, MD, India, in a separate video shows how to make a slit lamp breath protector.
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