Impact of teleconsultation on visual and refractive outcomes in patients undergoing laser refractive surgery during COVID-19.

Purpose: To assess the role of remote teleconsultation (TC) follow-up care following a successful and uneventful laser vision correction. Methods: The study is a retrospective, comparative analysis of patients undergoing laser vision correction at tertiary care eye hospital in Southern India. The patients were divided into two groups. The first group included patients operated on before the coronavirus disease (COVID-19) pandemic and were followed up with physical consultations during their follow-up visit (Group 1). The second group comprised patients operated on during the pandemic and had at least one remote TC during their post-operative follow-up (Group 2). Results: A total of 1088 eyes of 564 patients and 717 eyes of 372 patients were included in Group 1 and 2, respectively. The mean number of visits for the patients from Group 2 during the COVID period (2.56 +/- 0.74 days) was significantly lesser (P < 0.0001) than that of Group 1 in the pre-COVID period (3.53 +/- 1.07 days). Close to 90% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 in both groups (P = 0.925). 96.50% of the eyes in Group 1 and 98.18% of the eyes in Group 2 achieved UCVA 20/25 or better (P = 0.049). Eight eyes (0.73%) in Group 1 and one eye (0.14%) in Group 2 reported a loss of 2 or more lines. However, the results were not statistically significant (P = 0.156). None of the groups had any patients who had a sight-threatening complication. Conclusion: Remote TC following refractive surgery is safe and can be effectively integrated into routine refractive practice to reduce travel to the hospital for a physical consult.

Year one of COVID-19 pandemic: Effect of lockdown and unlock phases on cataract surgery at a multi-tier ophthalmology network.

Purpose: To describe the impact of lockdown and unlock phases of the COVID-19 pandemic on cataract surgery at a multitier ophthalmology network. Methods: This cross-sectional hospital-based study included 106,279 eyes operated between March 23, 2019 and March 31, 2021. The data of patients who underwent cataract surgery presenting during the lockdown and unlock phases were compared with the respective periods in the previous year before COVID-19. Results: The cataract surgeries performed decreased to 5.6% (839/14,994) of pre-COVID-19 volumes during the lockdown phase. There was a gradual recovery of the cataract surgeries performed to 86.7% of pre-COVID-19 volumes by May 2020 and exceeded by 17.9% by September 2020. There was a decrease in the number of women who underwent cataract surgery during the lockdown phase (49.11%) compared to the pre-COVID-19 (52.59%) or unlock phase (52.29%, P < 0.001). Patients operated during the lockdown phase were younger when compared to other groups (P < 0.001). The mean LogMAR presenting visual acuity at the time of surgery was worse in patients operated during the lockdown phase (1.84 ± 1.16) as compared to pre-COVID-19 (1.39 ± 1.05) and unlock phases (1.51 ± 1.08, P =<0.001). The proportion of patients with total cataracts were higher during the lockdown and unlock phases compared to the pre-COVID-19 phase (P < 0.001). Conclusion: The first year of the COVID-19 pandemic saw a drastic reduction in the surgical volume in the lockdown phase, which recovered quickly during the unlock period. Patients of younger age, male gender, poor presenting visual acuity, denser cataracts, and living close to the surgical center were able to access surgical care due to lockdown restrictions.

Effectiveness of simulation-based training for manual small incision cataract surgery among novice surgeons: a randomized controlled trial.

This study was designed to determine the effect of a novel simulation-based training curriculum for scleral tunnel construction in manual small incision cataract surgery (MSICS) compared with traditional training. In this multicenter, investigator-masked, randomized clinical trial, resident surgeons within 3 months of matriculation with minimal or no prior experience with MSICS were assigned either to simulation-based training, the Experimental Group (EG), or to conventional training, the Control Group (CG). EG residents were trained to perform scleral tunnel construction using a simulation-based curriculum (HelpMeSee Eye Surgery Simulator), while residents in the CG followed institution-specific curriculum before progressing to live surgery. Surgical videos of the first 20 attempts at tunnel construction were reviewed by masked video raters. The primary outcome was the total number of any of 9 pre-specified errors. On average, the total number of errors was 9.25 (95% CI 0-18.95) in the EG and 17.56 (95% CI 6.63-28.49) in the CG (P = 0.05); the number of major errors was 4.86 (95% CI 0.13-9.59) in the EG and 10.09 (95% CI 4.76-15.41) in the CG (P = 0.02); and the number of minor errors was 4.39 (95% CI 0-9.75) in the EG and 7.47 (95% CI 1.43-13.51) in the CG (P = 0.16). These results support that novice surgeons trained using the novel simulation-based curriculum performed fewer errors in their first 20 attempts at tunnel construction compared to those trained with a conventional curriculum.

A new normal with cataract surgery during COVID-19 pandemic.

Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.