Ocular Oncology Practice During the COVID-19 Pandemic

The COVID-19 pandemic created a worldwide shift in how physician deliver optimal medical care. Ocular oncology practices have had to adapt to new challenges including how the delivery of service is performed in order to minimize SARS-CoV-2 exposure without sacrificing quality. Understanding the individual characteristics of every practice will maximize the efforts to adapt to this new reality. Telemedicine, virtual waiting rooms, and personal protective equipment have become the new standard during these unprecedented times. During clinic and operating room, our practices have had to strive for a new level of synchrony between patient and physician availability to minimize wasted time and exposure risk. Overall, medical care should not be delayed or deferred in patients with malignant ocular tumors during the COVID-19 pandemic;however, implementing safety measures for patients and healthcare workers is crucial to successfully continue to practice ocular oncology. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Comparison of Tumor Size and Gene Expression at Presentation in Uveal Melanoma Patients before and during the COVID-19 Pandemic.

Introduction: The aim of this study was to compare the clinical and gene expression variables of uveal melanoma patients presenting before and after the start of the COVID-19 pandemic as surrogate markers in order to assess the pandemic's potential impact on care. Methods: We conducted a retrospective chart review of uveal melanoma patients at Retina Consultants of Texas and assessed tumor size, staging, and gene expression data during two time periods: May 2019 to February 2020 (Group 1: Before the COVID-19 pandemic declaration by the WHO in March 2020) and May 2020 to March 2021 (Group 2: After the start of the COVID-19 pandemic). Results: A total of 80 patients with uveal melanoma were studied (Group 1: 40 [50%] and Group 2: 40 [50%]). There was no statistically significant difference in the tumor thickness (p = 0.768), largest base dimension (p = 0.758), Collaborative Ocular Melanoma Study size class (p = 0.762), and American Joint Committee on Cancer stages (p = 0.872) between the two groups. Additionally, there was no difference in the tumors' gene expression data including gene expression profile class (p = 0.587) and PRAME expressivity (p = 0.861) between the two groups. Discussion/Conclusion: The COVID-19 pandemic had no effect on the presentation of uveal melanoma patients across all tumor characteristics including size, staging, and gene expression data, suggesting there was not a significant diagnostic delay in care for uveal melanoma patients at our center due to the pandemic.

Year 1 of COVID-19 pandemic in India: Effect of lockdown and unlock on the presentation of patients with ocular and periocular tumors at a referral center.

PURPOSE: The purpose of the study is to describe the impact of lockdown and unlock phases of the COVID-19 pandemic on the presentation of ocular and periocular tumors at a referral center in India. MATERIALS AND METHODS: This cross-sectional, hospital-based study included 5811 patients presenting between March 25, 2017, and March 31, 2021. The data on the patients diagnosed with ocular and periocular tumors in one or both eyes presenting during the lockdown and unlock phases were compared with the respective time periods in the previous 3 years before COVID-19. RESULTS: The patient numbers dropped by 85% (45/295) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 33% reduction in patients requiring inter-state travel. There was complete recovery of the outpatient numbers to 105% (139/132) of pre-COVID-19 volumes by March 2021. This gradual incremental trend was seen in patients with malignant tumors (145%) and was lower in those with benign tumors (89%) than pre-COVID-19 volumes by March 2021. There was an increase in the patients presenting with malignant tumors (49%; P = 0.45) during the lockdown phase. The proportion of patients requiring inter-state travel showed a near-complete recovery to 88% of pre-COVID-19 distribution by March 2021. CONCLUSION: The 1st year of the COVID-19 pandemic saw a significant decline in the number of patients presenting with ocular and periocular tumors. There was an increase in the proportion of malignant tumors and a decrease in benign tumors during the lockdown phase. During unlock period, there was a near-complete recovery in the patients requiring inter-state travel to access eye care services.

Impact of COVID-19 nationwide lockdown on retinoblastoma treatment and outcome: A study of 476 eyes of 326 children.

Purpose: The novel coronavirus SARS-CoV-2 (COVID-19) and the resultant nationwide lockdown and travel restrictions led to difficulty in providing timely and regular treatment to patients with childhood cancers such as retinoblastoma. This study is aimed at assessing the demography, clinical presentation, treatment strategies, and outcome of treatment defaulters due to the lockdown. Methods: Cross-sectional, observational study of retinoblastoma patients at a tertiary care ocular oncology center during the first wave of COVID-19 and the resulting nationwide lockdown. Results: Of the 476 eyes of 326 patients undergoing active management with a median age of 57 months (range: 4-214 months), 205 (63%) patients returned for follow-up after a mean delay of 45.8 ± 24.3 weeks (range: 8-80 weeks) and 121 (37%) were defaulters according to the data analyzed till June 30, 2021. Distance of residence was ≥1000 km for 148 patients (46%). In terms of need for active treatment, the number of emergent cases was 2 (<1%), 11 (3%) were urgent, and 313 (96%) were semi-urgent. International classification groups D (n = 107 eyes, 23%) and E (n = 173 eyes, 36%) were in majority, and 13 eyes (4%) and 4 eyes (1%) were at stages 3 and 4, respectively. Prior to lockdown, 86 eyes (18%) had active tumor, which remained unchanged (n = 26, 30%) or worsened (n = 49, 60%) after failure to follow-up. Vision (47%), eye (92%), and life salvage (98%) were achieved by individualized protocol-based management after the patients returned for further management. Five children succumbed to intracranial extension. Conclusion: The COVID-19-related nationwide lockdown has deprived retinoblastoma patients of optimal and timely management, leading to prolonged treatment interruptions, delays, permanent default, and death. It is of paramount importance for all the stakeholders to increase awareness, make necessary travel and logistic arrangements, and ensure continuity of care for children with retinoblastoma.

The Trends of Uveal Melanoma Research in the Past Two Decades and Future Perspectives.

Evaluation of the research trends in uveal melanoma in the past two decades. Data were extracted from the Web of Science database website. VOSviewer and Citespace software were used to analyze the retrieved data. The leading country in terms of output and international collaboration is the USA. Research interest in genetic mutations, molecular pathways, and immunotherapy was remarkable in recent years. Most of the top ten journals are specialized in ophthalmology. In recent years, the hotspots include future perspectives, BAP1 mutation, therapeutic target, and systematic reviews. The keywords with the strongest citation bursts are immunotherapy, outcome, and in situ hybridization. The output of uveal melanoma research increased during the past two decades. Before 2015, the main focus of the research was to facilitate prognostication and metastatic risk stratification. Recently, research has moved to examine the metastatic microenvironment. Future research foci may include exploring the role of different mutations, immunotherapy, molecular alterations, and finding ideal clinical biomarkers.

Ocular oncology service during the COVID-19 outbreak in Florence (Italy): Practical considerations for the management of patients.

The Coronavirus disease 2019 (COVID-19) outbreak has imposed the adoption of strategies to limit the risk of contagion for cancer patients without compromising their healthcare. As well as cancers of other sites, the treatment of certain ocular and periocular malignancies is considered non-deferrable and should proceed despite the pandemic. Delays in treatment of these patients may result in negative outcomes. Herein, we provide some practical considerations deriving from our experience at the Ocular Oncology Unit of Careggi University Hospital (Florence, Italy).

Ocular oncology practice guidelines during COVID-19 pandemic-An expert consensus.

The outbreak of rapidly spreading COVID-19 pandemic in December 2019 has witnessed a major transformation in the health care system worldwide. This has led to the re-organization of the specialty services for the effective utilization of available resources and ensuring the safety of patients and healthcare workers. Suspension of oncology services will have major implications on cancer care due to delayed diagnosis and treatment leading to irreversible adverse consequences. Therefore various oncology organizations have called for a continuation of cancer care during this crisis with diligence. The COVID-19 pandemic has forced the clinicians to transform the components of care from screening to outpatient care and primary management. The purpose of this article is to establish guidelines and recommendations for ocular oncology in the management of ocular tumors set by a multidisciplinary team of experts including ocular, medical and radiation oncologists, and pathologists. As the pandemic is evolving fast, it will require constant updates and reformation of health strategies and guidelines for safe and quality health care.