Psychological Impact of COVID-19 on Ophthalmologists in Iran.

Purpose: To identify the psychological impact of coronavirus disease on ophthalmologists practicing in Iran between August and December 2020. Methods: In this cross-sectional online survey, a standard Patient Health Questionnaire- 9 (PHQ- 9) was completed by 228 ophthalmologists who were practicing in Iran. The PHQ- 9 questionnaire was revised by adding two additional questions specifically applicable for the assessment of the psychological impact of coronavirus disease on the Iranian ophthalmologists. An organized classification regarding the assessment of different depression severities identified as no (0-4), mild (5-9), moderate (10-14), or severe (15-21) was then considered for data analysis. Results: The mean age of our participants was 49.0 ± 15.61 years and the majority of them (67.1%) were male. Depression was discovered in 73.68% (n = 168) with different severities ranging from mild (n = 61, 26.75%), moderate (n = 63, 27.63%), and severe (n = 44, 19.3%). It was found that participants with depression were older as compared to those without depression (P = 0.038). Higher percentages of severe depression were noticed in the high-risk regions contaminated with corona virus as compared to the other low-risk regions (P = 0.003). Based on multivariable models, we determined that ophthalmologists who were somewhat concerned about their training/ profession (OR: 0.240; 95% CI: 0.086-0.672; P = 0.007) and those with no concerns about their income had lower association with depression (OR: 0.065; 95% CI: 0.005-0.91; P = 0.042). Conclusion: High prevalence of depression was observed among older aged Iranian ophthalmologists living in high-risk contaminated regions who possessed serious concerns with respect to their training/profession and income. It is recommended that the health policymakers of Iran pay more attention to the ophthalmologists who experience the aforementioned factors.

Challenges and Future Implications for Ophthalmologists in COVID-19 Environment

In this brief communication, we have highlighted the challenges confronted by Ophthalmologists during COVID-19 pandemic and formulated steps to develop a comprehensive strategy towards minimizing risk of infection transmission between health care workers and patients. To reduce the risk of cross infection, screening and triaging of the patients was done at very initial stage with only high risk patients (red category) were seen directly on slit lamp biomicroscope with PPE. Green and yellow category (low risk) patients were seen via teaching aids or LCDS and telemedicine methods. Elective surgeries were postponed. Less number of attendants were allowed with the patients. Continued teaching services for undergraduate and post graduate students were done by online methods like zoom or Microsoft teams meeting. Departmental meetings were planned via video conferencing (zoom or Microsoft teams). Recommendations are made in this article to ensure safe access to specialized health care in face of COVID-19 pandemic. © 2021, Ophthalmological Society of Pakistan. All rights reserved.

The impact of COVID-19 pandemic on the professional activities and health of ophthalmologists in the Russian Federation. Results of an online survey

Purpose. To study the impact of the COVID-19 pandemic on the professional activities and health of ophthalmologists in the Russian Federation. Material and methods. The All-Russian online survey of ophthalmologists «Impact of the COVID-19 pandemic on the professional activity, lifestyle and health of ophthalmologists in the Russian Federation» was conducted. The results are presented as a percentage of those respondents who are engaged in the relevant activity. Results. The survey involved 582 ophthalmologists from various regions of Russia. In April 2020 (in the first month of non-working days throughout the Russian Federation), the work load as a whole became less than usual for 54.8% of respondents. In addition, 18.4% of respondents stated that they did not work during the entire April 2020. The number of face-to-face consultations decreased in 74.3% of the surveyed ophthalmologists. The number of telemedicine consultations decreased in 27.0% of respondents, and increased in 34.1%. The number of emergency and urgent surgery decreased in 25.0% of respondents, and increased in 23.2%. The number of planned surgery decreased in 80.4% of respondents. 23.9% of respondents began to provide medical care in an additional and new profile of ophthalmological care (which they do not usually do). Salaries in April 2020 decreased for 66.7% of respondents, in August 2020 - in 41.4% of respondents. Ophthalmologists have become more engaged in the study of professional literature on ophthalmology and coronavirus, as well as writing scientific products (articles, patents, etc.), preparing reports and presenting them. In 57.8% of cases of infection of ophthalmologists with COVID-19 was associated with their professional activities and 37.3% of infection with an ophthalmic patient. In 83.3% of cases, ophthalmologists were treated for COVID-19 on an outpatient, in 16.7% of cases - in an inpatient. In 66.7% of cases the health status of ophthalmologists after the coronavirus infection COVID-19 was poor. Conclusion. The COVID-19 pandemic had negative impact on the professional activity and health of ophthalmologists in the Russian Federation. © 2021 Architectural Institute of Japan. All rights reserved.

Sars-Cov-2 Pandemic from the Ophthalmologist`S Perspective. A Review

In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged from China. Coronaviruses belong to enveloped ssRNA viruses and are classified into four genera: Alpha coronavirus, Beta coronavirus, Gamma coronavirus and Delta coronavirus. It is assumed that SARS-CoV-2 is spread primarily during a personal contact via bigger respiratory droplets. These droplets with viruses can be directly inhaled by other people or can lend on the surfaces with the possibility of further spreading. The ocular surface has been suggested as one of possible infection entries. Human eye has its own renin-angiotensin system with present ACE2 receptors, which bind the virus through spike protein. The most common symptoms of the SARS-CoV-2 infection are fever, cough and dyspnoea. Several clinical entities, such as conjunctivitis, anterior uveitis, retinitis, and optic neuritis have been associated with this infection. The most common ophthalmologic symptom associated with COVID-19 disease is conjunctivitis. Some studies indicate that eye symptoms are commonly present in patients with severe COVID-19 pneumonia and that it is possible to detect viral RNA from the conjunctival sac of these patients. In ophthalmologic praxis, we manage not only the therapy of the eye structures` inflammation in relation with this infection, but also the overall management of the visits and the supervision of the patients who are at risk and positive for coronavirus. Ophthalmologists could potentially have a higher risk of SARS-CoV-2 infection due to personal communication with the patients, frequent exposure to tears and eye secrets and the use of devices. We would like to provide an ophthalmologist`s perspective on this topic.

Coronavirus Disease 2019 Virus among Ophthalmologists in Nigeria: Knowledge, Attitude, and Perceptions

AJOL : Background: Globally, there is still much to learn about the evolving coronavirus disease 2019 (COVID‑19) virus, its transmission, prevention, and treatment. Therefore, this study investigates the knowledge, perception, and screening practices of COVID‑19 infection in the ophthalmology practice in Nigeria. Materials and Methods: This survey was a descriptive, cross‑sectional survey conducted among practising ophthalmologists and ophthalmologists in training in Nigeria in an online survey. Data compiled were then analyzed using the IBM SPSS software version 22.0 with two‑tailed P < 0.05 considered to indicate statistical significance. Results: A total of 206 ophthalmologists/ophthalmologists in training were recruited for this study. Most of the respondents, 97 (47.1%), practiced in centres in South‑West Nigeria and were board‑certified ophthalmologists 96 (46.6%). In general, the majority of the respondents, 182 (88.3%), had good knowledge regarding the COVID‑19 virus, its transmission, prevention as it regards the ophthalmic practice, 134 (74.8%) either agreed or strongly agreed that the ophthalmologist is at a higher risk of contracting the virus from infected patients even if the patient is asymptomatic. COVID‑19 infection was perceived as very serious by the majority of the respondents, 135 (65.5%), although 128 (62.1%) felt that all routine cases should be seen only following a low‑risk assessment. Conclusion: As the world races toward complete vaccination of the population against this fatal infection, continued training is required to ensure the best practices among ophthalmologists to bridge the present knowledge gaps, corrects myths, misconceptions, and ensure the safety of both the patient and the ophthalmologist

Conjunctivitis as the only sign and symptom of COVID-19: A case report and review of literature.

Similar to several viruses, coronaviruses can affect the eye and cause conjunctivitis. In addition to ocular involvement, it causes systemic manifestations, mainly respiratory symptoms. However, conjunctivitis as the only sign and symptom of coronavirus disease 2019 (COVID-19) is a rare presentation. We present a case of a 20-year-old male patient who presented with conjunctivitis for 3 days and diagnosed on the same day with COVID-19 without other manifestations. Conjunctivitis affected both eyes and resolved over 2 weeks with artificial tears only and without any ocular complications. Conjunctivitis can be the only sign and symptom of COVID-19 in some patients. Therefore, healthcare providers, particularly ophthalmologists, should take precautions when dealing with patients presenting with conjunctivitis amid the COVID-19 pandemic.

The Role of Infection Control Measures in Ophthalmology: Do They Prevent COVID-19 Infection Among Ophthalmologists in Egypt? A Survey-Based Study.

INTRODUCTION: Ophthalmologists are at a high risk of coronavirus disease 2019 (COVID-19) infection owing to their working environments and proximity to patients during examinations. Compliance with infection control measures in examination offices can lessen the risk of infection to this group. In Egypt, several deaths from COVID-19 have been reported among ophthalmologists; therefore, we studied the prevalence of COVID-19 infections in this group and assessed ophthalmologists' commitments to recommended infection control measures. AIM: To evaluate the rate of COVID-19 infections among ophthalmologists, identify risk factors for infections, and evaluate ophthalmologists' commitments to infection control measures in their medical facilities. METHODS: An online questionnaire was designed and distributed to ophthalmologists in the Cairo Governorate from May 1, 2021 to mid-June 2021. RESULTS: Out of 161 responders, the percentage of COVID-19 infections was 52.8% (85 responders). This was significantly higher among younger ophthalmologists (P-value = 0.019) and those with fewer years of experience (P-value = 0.010). Adopting full precautions while examining patients with or without respiratory illness were significantly associated with a lower infection rate (P-value = 0.019 and 0.046, respectively). A significantly higher infection rate was reported for ophthalmologists who examined known COVID-19 patients at outpatient clinics, even when taking precautions (P-value = 0.032). A lower rate of COVID-19 infection was significantly associated with adopting full precautions while operating on suspected or nonsuspected COVID-19 patients (P-value = 0.007 and 0.003, respectively). CONCLUSION: Both young age and limited experience were significant infection risk factors in our study. The most important infection control measures that significantly decreased infection risks were adherence to full protective measures while working in outpatient clinics and operating rooms.

The Impact of COVID-19 Pandemic on Practice Patterns and Psychological Status of Ophthalmologists in Turkey.

AIM: To investigate the changes in ophthalmologists' working conditions and mental health status in Turkey during the first wave of the COVID-19 outbreak and reveal the relevant individual and workplace-related factors. METHODS: This cross-sectional, nationwide, the survey-based study collected data between June and September 2020. Demographic characteristics, working conditions, precautionary measures in the workplace, and participants' Depression Anxiety Stress Scale (DASS-21) and Insomnia Severity Index (ISI) ratings were investigated. RESULTS: This study included 360 actively working ophthalmologists. While 64% of them worked in the pandemic hospitals, 44% were actively involved in COVID-related departments. Among those, 56 (35%) declared that they had all personal protective equipment in sufficient quantity in their COVID department. Despite the restrictions, 32% reported continuing to see 25 to 50 patients per day in ophthalmology clinics, with the most common complaint being the ocular "itching and burning" sensation. 53% stated that they did not perform any surgeries. Symptoms of depression, anxiety, stress and insomnia were present in 65%, 56.9%, and 43% and 46.9% of participants, respectively. All DASS-21 subscales and ISI scores were found to be significantly higher during the pandemic. Female gender, older age, and lower satisfaction levels of hygiene conditions in COVID clinics were independent predictors of higher DASS-21 subscale scores in multivariate analysis. Being a resident was a major predictor of depression. Ophthalmologists working in a pandemic hospital were more likely to experience insomnia. CONCLUSION: Ophthalmologists have actively worked in COVID departments during the pandemic. Increased psychological distress among ophthalmologists compared to the pre-pandemic period is caused by personal factors and many determinants related to the workplace and practice patterns. Therefore, decreasing the transmission risk by creating a protective workplace and developing psychological support policies should be considered to minimize adverse psychological effects.

All India Ophthalmological Society Financial Impact Survey on ophthalmology practice in India during COVID-19.

PURPOSE: A survey was conducted by the All India Ophthalmological Society (AIOS) to document the initial coronavirus disease 2019 (COVID-19)-related financial impact on ophthalmology practice in India. It also assessed various measures taken by ophthalmologists and the possible role of AIOS in mitigating the economic crisis. METHODS: An online questionnaire-based cross-sectional survey was conducted among its registered members from July to August 2020. The prevalidated questionnaire contained 25 items related to the impact of COVID-19 on patient volume, the extent of financial distress faced by the ophthalmologists, and various proactive measures taken by them. All valid responses were tabulated and analyzed. RESULTS: Out of 1,026 respondents, more than 90% ophthalmologists faced a 25% or more reduction in outpatient and surgical volume. Nearly 59% reported that they can suffer from serious financial distress in near future due to COVID-19 pandemic-related losses. Those who are young (P < 0.0005), salaried (P < 0.0005), and practicing in private sector (P < 0.0005) and Tier 1 cities (P < 0.0005) are reported to be more vulnerable to become financially unstable. The major concerns were revenue losses (70%), preexisting debts (39%), and increased operating costs (27%). The majority (90%) believed that AIOS can help in alleviating the distress. There was also hesitancy regarding the adoption of teleophthalmology and home-based care. CONCLUSION: COVID-19 has significantly affected the financial sustainability of ophthalmologists practicing in India. Identification of vulnerable groups and timely advocacy efforts by AIOS can help in mitigating this financial crisis.

Challenges of personal protective equipment use among ophthalmologists during the COVID-19 pandemic: A multicenter international study.

PURPOSE: To explore the possible challenges and difficulties of using Personal Protective Equipment (PPE) in ophthalmic practice during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS: This is a multicenter, international survey among practicing ophthalmologists across different countries. The survey was conducted from September 9th to October 24th, 2020. It included a total of 23 questions that navigated through the currently adopted recommendations in different clinical situations. The survey also assessed the convenience of using various PPE in ophthalmic practice and addressed the clarity of the examination field while using various PPE during clinical or surgical procedures. RESULTS: One hundred and seventy-two ophthalmologists completed the survey (101 from Egypt, 50 from the USA, and 21 from four other countries). The analysis of the responses showed that most ophthalmologists use face masks without significant problems during their examinations, while face shields followed by protective goggles were the most inconvenient PPE in the current ophthalmic practice. Moreover, most of the participants (133, 77.3%) noticed an increase in their examination time when using PPE. Furthermore, a considerable percentage of the respondents (70, 40.7%) stopped using one or more of the PPE due to inconvenience or discomfort. CONCLUSIONS: Due to the unique nature of the ophthalmic examination, certain PPE are not ophthalmologist-friendly. Innovative PPE should be tailored for prompt, more convenient, and clearer ophthalmological practice.

Evidence-based of conjunctival COVID-19 positivity: An Italian experience: Gemelli Against COVID Group.

BACKGROUND: The possible transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) by tears and conjunctiva is still debated. METHODS: Main outcome was to investigate the agreement between nasopharyngeal swab (NPs) and conjunctival swabs (Cs) in patients with SARS-CoV-2 infection. We divided patients into four groups: (1) NPs and Cs both negative (C-NF-), (2) NPs positive and Cs negative (NFs+Cs-), (3) NPs negative and Cs positive (NFs-Cs+), and (4) NPs and Cs both positive (NFs-Cs+). The secondary outcomes were to correlate Cs results with systemic clinical parameters such as: oxygen saturation (SpO2), dyspnea degree (DP), radiologic pulmonary impairment based on chest radiography (XR) or computed tomography (CT), blood chemistry as D-Dimer (D-Dimer), fibrinogen, ferritin, lactate dehydrogenase (LDH), and C-reactive protein (C-RP). RESULTS: A total of 100 conjunctival swabs in 50 patients with SARS-CoV-2 have been enrolled in this interventional clinical trials. Ocular signs (conjunctivitis) were present in five patients (10%). NPs and Cs highlighted a poor level of agreement (0.025; p = 0.404). Median SpO2 levels are the highest in the NF-C- group (98%) and the lowest (90%) in the group NF+C+ (p = 0.001). Pulmonary impairment was statistically significantly different between NFs and Cs groups (p = 0.019). Pulmonary impairment score increased from NFs-Cs- group (3.8 ± 3.9), to NFs+Cs+ group (6.7 ± 4.1). Intensive care unit patients showed higher COVID-19 Cs positivity in conjunctiva (12.5%) against hospitalized ones (5.8%). CONCLUSIONS: In patients hospitalized for SARS-CoV-2 the virus can be detected in conjunctival swab. Intensive care unit patients may reveal a higher COVID-19 presence in the conjunctiva. The most severe pulmonary impairment can be observed in NFs and Cs positivity. TRIAL REGISTRATION: Clinicaltrials.gov registration. ETHICAL COMMITTEE AUTHORIZATION: ID number: 0013008/20.

Impact of COVID-19 Pandemic on Young Ophthalmologists in Cairo University Hospitals.

PURPOSE: To assess the concerns of the residents and young ophthalmologists as well as the change in their practice during the COVID era. DESIGN: This is an cross-sectional study. METHODS: A questionnaire was directed to the young Ophthalmologists of Ophthalmology department in Cairo University hospitals. The primary outcome measures were the effects of COVID-19 pandemic on ophthalmology practice. RESULTS: Seventy-nine young Ophthalmologists responded to the questionnaire, with an age ranging from 24 to 36 years of age of which 57% were females. They all practiced Ophthalmology from less than one year up to 9 years long, with 55.8% of them feeling unlucky starting ophthalmic practice during this era, 7.6% are extremely anxious regarding their psychological concern about the pandemic, and some feel they need psychological assessment especially those with 1-3 years duration of practice (41.2%) (p = .011) , especially females (82.4%, p = .015 ). As for access to PPE, 94.9% are wearing masks in the clinic, but only 8.9% of patients are wearing masks. Before this lockdown, 16.7% of the enrolled candidates attended on line lectures and webinars, but since then, this has significantly surged to 80.5% (p < .001) . CONCLUSION: Due to COVID-19 pandemic, as with everybody else, our young ophthalmologists have been affected on many different levels; psychologically, education and practice levels.

Ocular tropism of coronavirus (CoVs): a comparison of the interaction between the animal-to-human transmitted coronaviruses (SARS-CoV-1, SARS-CoV-2, MERS-CoV, CoV-229E, NL63, OC43, HKU1) and the eye.

PURPOSE: Several studies have reported conflicting results on ocular manifestations and transmission of coronavirus disease 2019 (COVID-19) whose causative virus, SARS-CoV-2, belongs to the coronavirus family, the seventh recognized as a human pathogen and the third causing a severe clinical syndrome. COVID-19 primarily affects the lungs, similar to the other human coronaviruses. Comparing the relation between the animal-to-human transmitted coronaviruses (SARS-CoV-1, SARS-Cov-2, MERS-CoV, CoV-229E, NL63, OC43, HKU1) and the eye may contribute to determining their actual eye-tissue tropism and risk of ocular transmission. METHODS: Literature review was conducted via Pubmed.gov, Google Scholar and medRixv using the following keywords: COVID-19, SARS-CoV-2, SARS-CoV-1, MERS-CoV, CoV-229E, NL63, OC43, HKU1, conjunctivitis, tear swab, ocular expression, ocular symptoms and human angiotensin converting enzyme-2 expression. Studies with lack in methodology were excluded. RESULTS: Sixteen observational studies were selected. The range for detection of viral RNA in tears was 0-8% for SARS-CoV-1 and 0-5.3% for SARS-CoV-2, while no reports were found for other coronaviruses. Ocular manifestations have been reported for NL63 and SARS-CoV-2. Ocular symptoms in the form of conjunctivitis/conjunctival congestion predominantly were detected in 65 (3.17%) out of 2048 reported patients with COVID-19 (range of 0.8-32%). Eye symptoms were not reported for the other coronaviruses. CONCLUSIONS: Data aggregation for coronaviruses shows a relatively low eye-tissue tropism. Conjunctival congestion is an uncommon manifestation of COVID-19 similar to all human coronaviruses' infections. In a low percentage of patients, the virus can be excreted in ocular fluids at different stages of the infection, regardless of positive SARS-Cov-2 throat swab. Albeit high viral loads in ocular tissue seem to have relatively low prevalence, the eye should be regarded as a potential source of infection dissemination for COVID-19.

Effect of 2019 Coronavirus Pandemic on Ophthalmologists Practicing in Saudi Arabia: A Psychological Health Assessment.

PURPOSE: To assess the psychological impact and mental health outcomes including depression, anxiety, and insomnia during COVID-19 crisis among ophthalmologists. METHODS: This was a simple random study in which ophthalmologists practicing in Saudi Arabia were asked to fill in a self-administered online survey during the period from March 28, 2020, to April 04, 2020. Four validated psychiatric assessment tools were used to detect symptoms of depression, anxiety, insomnia, and stress perception. RESULTS: One hundred and seven participants successfully completed the survey with a response rate of 30.6%. Males constituted 56.1% (n = 60). Ophthalmology residents constituted the majority (n = 66, 61.7%). About half of the physicians exhibited symptoms of depression (n = 56, 50.5%), anxiety (n = 50, 46.7%), and insomnia (n = 48, 44.9%). Symptoms of stress ranged between low (28%), moderate (68.2%), and high (3.7%). According to the cutoff values for severe symptoms, 29% were identified as having depression, 38.3% had anxiety, and 15% had insomnia.Depression was found to be more common among female ophthalmologists (P = 0.06), those living with an elderly (P = 0.003), and fellows (P = 0.006). Female ophthalmologists suffering from anxiety were significantly more than male ophthalmologists (P = 0.046). There was a trend toward suffering from anxiety in frontline health-care providers (P = 0.139) and in ophthalmologists who are living with an elderly (P = 0.149). Female participants exhibited significantly more moderate-to-high symptoms of stress (P = 0.018). CONCLUSIONS: Ophthalmologists' psychological needs, females in particular, should be addressed appropriately during the COVID-19 pandemic. Establishing psychological support units, especially for high-risk individuals, should be considered to minimize psychological adverse effects.

Awareness, Perceptions, and Attitude Regarding Coronavirus Disease 2019 (COVID-19) Among Ophthalmologists in Jordan: Cross-Sectional Online Survey.

PURPOSE: COVID-19 pandemic is a serious public health concern, and the role of health care workers is essential in preventing spread. The study objective is to investigate awareness, perception, and attitude towards COVID-19 and infection control measures among ophthalmologists in Jordan. METHODS: The design of the study was a cross-sectional survey among Jordanian ophthalmologists. An online survey was sent to 197 ophthalmologists on March 23, 2020. Information on participants' socio-demographic characteristics, knowledge of clinical features of COVID-19, risk assessment and infection control measures for preventing disease transmission, and attitude towards treating patients with COVID-19 were collected. RESULTS: A total of 132 ophthalmologists (mean age 40.5 years) responded, 23 (17.6%) had received training on infection control in ophthalmology. Most ophthalmologists were aware of COVID-19 symptoms and ways to identify patients at risk of having the disease, correctly reported modes of transmission and were aware of measures for preventing COVID-19 transmission in the ophthalmic setup. Social media was the commonest source of information on COVID-19 (75%), and 38.2% were not provided with instructions on infection control plan to reduce transmission of COVID-19. Most ophthalmologists (79.5%) thought that the virus could be detected in tears, and 72.2% thought that red eye as a symptom of COVID-19. CONCLUSION: Ophthalmologists in Jordan were aware of the epidemiology of COVID-19 and related infection preventive measures. Knowledge was lacking regarding ocular aspects of the disease. Training on infection prevention needs to be improved. Access to guidelines from international ophthalmological organizations should be promoted and seeking updated literature from peer-reviewed journals needs to be encouraged.

Post-COVID-19 and the Portuguese national eye care system challenge.

The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health care systems. Regarding Portugal, a suppression strategy with social distancing was adopted, attempting to break the transmission chains, bending the epidemy curve and reducing mortality. These measures seek to prevent an eventual National Health Service over-running, enforcing the suspension of all elective and non-urgent health care. Despite the success in so far, there is a consensus on the need to recover the previous level of health care provision and further enhance it. The Portuguese National Health Service, as a public, universal access, health care system funded by the State proved, in this context, its importance and relevance to the Portuguese population. However, long standing issues, such as the pre pandemic over long waiting lists for hospital ophthalmology attendance, whose determinants are fully identified but still unmet, emerge amplified from this pandemic. The lack of primary eye care in the National Health Service is a significant bottleneck, placing a huge stress on hospital-based care. An exclusive ophthalmologist's center care was over-runned before pandemic and will be even more so. The optometrist's exclusion from differentiated, multisectoral and multidisciplinary eye care teams remains the main hurdle to overcome and insure universal eye care in Portugal. National Health Service highlights the consequences of an overcome model. Universal eye care more than ever demands an evidence-based, integrated approach with primary eye care, in the community, on time and of proximity.

La pandemia del síndrome respiratorio agudo grave causado por el nuevo coronavirus SARS-CoV-2 (COVID-19) ha tenido amplias repercusiones en muchos países y en sus sistemas sanitarios. En Portugal, se ha adoptado una estrategia de contención basada en el distanciamiento social, con la cual se ha intentado cortar las cadenas de transmisión, frenar la curva de la epidemia y reducir la mortalidad. Con estas medidas se trataba de evitar un eventual desbordamiento del Servicio Nacional de Salud y se imponía la suspensión de toda la atención médica programada, que no fuera urgente. A pesar del éxito logrado hasta este momento, existe consenso sobre la necesidad de recuperar el nivel anterior de atención médica y fomentar su mejora. El Servicio Nacional de Salud de Portugal, como sistema sanitario público y de acceso universal, a cargo del Estado, ha demostrado, en este contexto, su importancia y pertinencia para la población portuguesa. Sin embargo, los problemas que acarrea desde hace mucho tiempo, como las largas listas de espera, anteriores a la pandemia, en la asistencia oftalmológica hospitalaria, cuyos factores determinantes están completamente identificados, pero que continúan sin solución, se han visto agravados a resultas de esta pandemia. La falta de atención primaria oftalmológica en el Servicio Nacional de Salud es un importante cuello de botella, que ejerce una enorme presión en la atención hospitalaria. La atención de un centro exclusivamente oftalmológico estaba desbordada antes de la pandemia y lo estará aún más después de esta. La exclusión de los optómetras de los equipos de atención oftalmológica diferenciados, multisectoriales y multidisciplinarios continúa siendo el principal obstáculo que debe superar y asegurar la atención oftalmológica universal en Portugal. El Servicio Nacional de Salud hace hincapié en las consecuencias de un modelo superado. La atención oftalmológica universal exige, más que nunca, un enfoque integral basado en la evidencia para abordar la atención primaria oftalmológica en la comunidad, puntual y de proximidad.

Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India.

Purpose: To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India. Methods: An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training or practising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9). Results: In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in 101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses. Conclusion: A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.