A review on the use of telemedicine in glaucoma and possible roles in COVID-19 outbreak.

We review the use of telemedicine in glaucoma and its possible roles in the COVID-19 outbreak. We performed a literature search of published human studies on teleglaucoma on May 12, 2020, using search terms including "telemedicine" and "glaucoma" that were in English and published over the prior 10 years. This search strategy yielded a total of 14 relevant articles after manual curation. Of the 14 articles, 4 were from the same randomized control trial, 7 were prospective studies, 2 were retrospective studies, 1 was descriptive analysis, and 1 was cost-effective analysis. Seven discussed the common ophthalmologic measurements used in teleglaucoma. Four demonstrated the cost effectiveness of the use of teleglaucoma, and 3 articles investigated patient satisfaction with the use of teleglaucoma. Three articles investigated the correlation between teleglaucoma and face-to-face clinics. Five articles discussed the current use and opportunities of teleglaucoma. When compared to in-person care, teleglaucoma is more time and cost-effective, shows high patient satisfaction and fair to good agreement with in-person care; however, there is great variation in the reported sensitivity of glaucoma screening, warranting further studies to establish its efficacy. For glaucoma management, both the sensitivity and specificity must be further improved before it could be put into extensive use. Nevertheless, it is worthwhile to explore the possible extensive application of teleglaucoma in monitoring "glaucoma suspects" and maintaining glaucoma follow-up during a pandemic outbreak to reduce the risk of transmission of infection.

Aerosolization and Fluid Spillage During Phacoemulsification in Human Subjects.

BACKGROUND: Concerns had been raised for the potential hazard of SARS-CoV-2 transmissions via aerosols and fluid droplets during cataract surgeries amid the COVID-19 pandemic. This study aims to evaluate the rate of visible aerosol generation and fluid spillage from surgical wounds during phacoemulsification in human subjects. METHODS: This is a prospective consecutive interventional case series. High-resolution video captures of 30 consecutive uncomplicated phacoemulsification surgeries, performed by 3 board-certified specialists in ophthalmology, were assessed by 2 independent and masked investigators for intraoperative aerosolization and fluid spillage. Water-contact indicator tape was mounted on the base of the operating microscope, around the objective lens, to detect any fluid contact. RESULTS: No visible intraoperative aerosolization was detected in any of the cases, irrespective of different surgical practices among the surgeons with regard to wound size and position, lens fragmentation technique, power settings and means of ocular lubrication, or the different densities of cataract encountered. Large droplets spillage was noted from the paracentesis wounds in 70% of the cases. For all cases where fluid spill was detected on video, there was no fluid contact detected on the water-contact indicator tape. CONCLUSION: Visible aerosolization was not detected during phacoemulsification in our case series. Although the rate of fluid spillage was high, the lack of detectable contact with the indicator tape suggested that these large droplets posed no significant infectious risks to members of the surgical team.