Preoperative COVID-19 RT-PCR Testing of Asymptomatic Patients for Ophthalmic Surgery: Experience from Two Tertiary Referral Centers

Purpose: The aim of this study was to evaluate how prevalent asymptomatic SARS-CoV-2 virus infection (COVID-19) is among patients undergoing ophthalmic surgery at two tertiary referral hospitals. Material(s) and Method(s): This retrospective study included patients without COVID-19 symptoms who underwent preoperative screening using reverse transcription-polymerase chain reaction (RT-PCR) before ophthalmic surgery at the Kocaeli University and Gaziantep University departments of ophthalmology [between September 1, 2020, and December 15, 2020 (group 1);between March 1, 2021, and May 30, 2021 (group 2)]. Patients scheduled for surgery and followed up in the retina, glaucoma, pediatric ophthalmology and strabismus, cataract and refractive surgery, and cornea departments were examined. Result(s): RT-PCR was positive for SARS-CoV-2 in 12 (1.4%) of 840 patients in group 1 and 7 (1.1%) out of 600 patients in group 2. None of the patients were symptomatic of COVID-19. The majority of the patients were scheduled for retina or cataract and refractive surgery in both groups (group 1;retina: 29.2%, cataract and refractive: 57.0%, group-2;retina: 31.3%, cataract and refractive: 54.5%). SARS-CoV-2 RT-PCR testing was positive for seven patients in group 1 (7/245, 2.9%) and five patients in group 2 (5/188, 2.6%) who were scheduled for retinal surgery. Conclusion(s): The necessity, availability, and practicality of COVID-19 RT-PCR testing prior to ophthalmic surgeries varies depending on the protocols of each institution. COVID-19 RT-PCR testing is suggested especially before vitreoretinal surgeries and general anesthesia procedures, because of the difficulty in managing postoperative complications.Copyright © 2023 Gazi Eye Foundation. All rights reserved.

A Cross-Sectional Prevalence Study of Myopia and High Myopia during COVID-19 Pandemic

Purpose : The COVID-19 pandemic has caused societal, behavioral changes that have resulted in increased near work and less outdoor time. These changes may influence myopia progression. We performed a retrospective, cross-sectional prevalence study on the population base in Olmsted County, Minnesota to determine if there are short-term changes in myopia. Methods : Individuals living in Olmsted County who received ophthalmic care at Mayo Clinic Rochester from 2018 to 2021 were analyzed. Exclusion criteria included 1) visually significant cataract, 2) pseudophakia, 3) prior refractive surgery and 4) Age < 6 years. Manifest refractions were converted to spherical equivalent (SE). Patients with a SE ≤ -0.5 D were classified as myopic while SE ≤ -6.0 D were classified with high myopia. Individual age, sex, visual acuity, and lens prescription data were recorded. An algorithm was designed to estimate prevalence for patients without a manifest refraction utilizing their visual acuity, as was used in the NHANES study . Results : We sampled 11,783 invidiual records (8,413 adults;3,370 children). In adults from 2018 to 2021, the prevalence of myopia was similar at 61% vs 59% (p=0.3887) and high myopia was also similar at 10% vs 9.9% (p=0.5447). In children from 2018 to 2021, the prevalence of both myopia was similar at 21% vs 17% (p=0.2) and high myopia was also similar at 2.6% and 3.8% (p=.37). Conclusions : From 2018 to 2021, we did not find any trends in myopia development over a relatively brief, 4-year window in either pediatric or adult patients living in Olmsted County, Minnesota.

Ophthalmology in a virtual world: The impact of the COVID-19 pandemic on specialty conferences

Purpose : The COVID-19 pandemic led to unprecedented cancellation or alteration of healthcare events and medical conferences around the world. Many ophthalmology conferences transitioned to virtual interfaces, and the impact of this transition on the ophthalmology community is unclear. The authors wish to objectively define the impact of the COVID-19 pandemic on subspecialty ophthalmology conferences. Methods : This study included data from the following five ophthalmology conferences from 2019, 2020, and 2021, as available: American Glaucoma Society (AGS), American Society of Ophthalmic and Plastic Reconstructive Surgery (ASOPRS), American Society of Cataract and Refractive Surgery (ASCRS), North American Neuro-Ophthalmology Society (NANOS), and Women in Ophthalmology (WIO). Data requested from organizations included the following, as available: Number of total conference attendees, number of attendees stratified by level of training, number of attendees stratified by identified gender, and number of research s or presentations (submitted and/or accepted). This study has been approved by the City University of New York Institutional Review Board. Results : In our study, 60% of organizations demonstrated an increase in number of attendees when using a virtual interface compared to their in-person events. 80% of organizations demonstrated a marked increase in attendance by trainees on their virtual interfaces. 60% of organizations displayed a decrease in number of submitted s when using a virtual interface. 40% of organizations experienced an increase in number of accepted posters and presentations through a virtual platform. Conclusions : Virtual conference interfaces have the potential to increase overall attendance and research participation within the ophthalmology community. Organizations should consider a hybrid model that incorporates aspects of both virtual and in-person interfaces to potentially maximize attendance, outreach, dissemination of information, opportunity, and minimize costs.

USING THE TEAR FILM IMAGER FOR COVID19 DETECTION-A PILOT STUDY

Purpose : <div style='direction: ltr;'>A key challenge in limiting the spread of Covid-19 is the absence of a fast non-invasive tool to detect infected individuals in the general population. Using polymerase chain reaction (PCR) testing, it has been demonstrated that SARS-CoV-2 is present in the tear film of patients with ocular symptoms. The presence of virions in or next to the lipid layer of the tear film would theoretically cause a measurable interruption of the normal tear bi-layer structure. The goal of this pilot study is to test the hypothesis that a specialized version of Tear Film Imager (vTFI) could be used for detection of infected individuals, in a quick, non-invasive manner. It is important to note that vTFI findings are not specific to SARS-Cov-2, and similar enveloped virions might cause a comparable disturbance.</div> Methods : <div style='direction: ltr;'>In our pilot study, twenty eyes of ten patients that were hospitalized due to Covid-19 infection in a designated quarantine department were compared to twenty eyes of ten healthy control patients. The study was approved by the Wolfson medical center's Institutional Review Board. All participants had a nasopharyngeal PCR swab confirming infection status up to 72 hours prior to examination by vTFI. Any patients with chronic viral infection (i.e. HIV, HBV etc'), corneal abnormalities, or corneal/refractive surgery were excluded to ensure uniformity of the data and focus on virion detection</div> Results : <div style='direction: ltr;'>Using vTFI 16 out of 20 healthy eyes correctly tested negative. 15 out of 20 Covid-positive eyes were correctly identified positive using TFI. In total 70% of the control group were correctly categorized by TFI algorithm as healthy (positive if one eye positive) and 80% of the Covid-infected individuals were positively identified.</div> Conclusions : <div style='direction: ltr;'>Identification of Covid-19 status from the tear film layer using ultra-fast non-invasive vTFI shows promise and a larger sample blinded study should be performed to assess its implementation in an outpatient setting. Being a nonspecific test, the use of vTFI is not dependent on special primers and may offer a modality for diagnosing individuals suspected of being infected with other emerging pathogens. </div>.

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.

Global Tendency and Frontiers of Research on Myopia From 1900 to 2020: A Bibliometrics Analysis.

Background: Myopia is one of the most common causes of vision impairment in children and adults and has become a public health priority with its growing prevalence worldwide. This study aims to identify and evaluate the global trends in myopia research of the past century and visualize the frontiers using bibliometric analysis. Methods: The literature search was conducted on the Web of Science for myopia studies published between 1900 and 2020. Retrieved publications were analyzed in-depth by the annual publication number, prolific countries and institutions, core author and journal, and the number of citations through descriptive statistics. Collaboration networks and keywords burst were visualized by VOSviewer and CiteSpace. Myopia citation network was visualized using CitNetExplorer. Results: In total, 11,172 publications on myopia were retrieved from 1900 to 2020, with most published by the United States. Saw SM, from the National University of Singapore, contributed the most publications and citations. Investigative Ophthalmology & Visual Science was the journal with highest number of citations. Journal of Cataract and Refractive Surgery with the maximum number of publications. The top 10 cited papers mainly focused on the epidemiology of myopia. Previous research emphasized myopia-associated experimental animal models, while recent keywords include "SMILE" and "myopia control" with the stronger burst, indicating a shift of concern from etiology to therapy and coincided with the global increment of incidence. Document citation network was clustered into six groups: "prevalence and risk factors of myopia," "surgical control of myopia," "pathogenesis of myopia," "optical interventions of myopia," "myopia and glaucoma," and "pathological myopia." Conclusions: Bibliometrics analysis in this study could help scholars comprehend global trends of myopia research frontiers better. Hundred years of myopia research were clustered into six groups, among which "prevalence and risk factors of myopia" and "surgical control of myopia" were the largest groups. With the increasing prevalence of myopia, interventions of myopia control are a potential research hotspot and pressing public health issue.

Are we advancing universal health coverage through cataract services? Protocol for a scoping review.

INTRODUCTION: Universal health coverage (UHC) includes the dimensions of equity in access, quality services that improve health and protection against financial hardship. Cataract continues to be the leading cause of blindness globally, despite cataract surgery being an efficacious intervention. The aim of this scoping review is to map the nature, extent and global distribution of data on cataract services for UHC in terms of equity, access, quality and financial protection. METHODS AND ANALYSIS: The search will be constructed by an Information Specialist and undertaken in MEDLINE, Embase and Global Health databases. We will include all published non-interventional primary research studies and systematic reviews that report a quantitative assessment of access, equity, quality or financial protection of cataract surgical services for adults at the subnational, national, regional or global level from population-based surveys or routinely collected health service data since 1 January 2000 and published through to February 2020.Screening and data charting will be undertaken using Covidence systematic review software. Titles and abstracts of identified studies will be screened by two authors independently. Full-text articles of potentially relevant studies will be obtained and reviewed independently by two authors against the inclusion criteria. Any discrepancies between the authors will be resolved by discussion, and with a third author as necessary. A data charting form will be developed and piloted on three studies by three authors and amendments made as necessary. Data will be extracted by two reviewers independently and summarised narratively and using maps. ETHICS AND DISSEMINATION: Ethical approval was not sought as the scoping review will only use published and publicly accessible data. The review will be published in an open access peer-reviewed journal. A summary of the results will be developed for website posting, stakeholder meetings and inclusion in the ongoing Lancet Global Health Commission on Global Eye Health.

Public Interest in Refractive Diseases and Treatments During the COVID-19 Pandemic: A Google Trends Analysis.

Purpose To assess national internet search trends/public interest in refractive diseases and treatments during the first year of the COVID-19 pandemic. Methods A Google Trends search for refractive terms was performed during the first year of the COVID-19 pandemic. Refractive terms were divided into disease and treatment terms. Relative search volume (RSV) indices were assessed in the United States from the initial lockdown period (March 1 - June 28), summer reopening period (July 5 - November 1), and winter case surge/vaccine rollout period (November 8 - February 28). A t-test of two independent samples assuming unequal variances was utilized in comparing the pandemic year to pooled data of overlapping weeks between 2016-2019.  Results The majority of disease and treatment terms showed a significant decrease in RSV during the initial lockdown period (p<0.05). There was a significant increase in RSV for cataract, astigmatism, cataract surgery, and photorefractive keratotomy (PRK) (p<0.05), accompanied by a significant decrease in RSV for contact lens during the summer reopening period. There was a significant increase in RSV for cataract, astigmatism, glasses, and PRK, accompanied by a significant decrease in RSV for hyperopia, keratoconus, contact lens, and LASIK during the winter case surge/vaccine rollout period.  Conclusion There was a significant decrease in the public interest in refractive diseases and treatments during the lockdown period, accompanied by an increase in interest later in the year. Decreased public interest can lead to delays in care, poorer health literacy, and potentially worse outcomes. Strategies to enhance public interest and care during the pandemic may prove to be beneficial.

Impact on refractive surgery due to increasing use of personal protection equipment: Insights from EUROCOVCAT group.

Since the World Health Organization declared COVID-19 to be a pandemic on 11th March 2020, changes to social and sanitary practices have included significant issues in access and management of eye care during the COVID-19 pandemic. Additionally, the fear of loss, coupled with social distancing, lockdown, economic instability, and uncertainty, have led to a significant psychosocial impact that will have to be addressed. In the current COVID-19 pandemic, personal protective equipment such as face masks or face coverings have become a daily necessity. While "mass masking" along with hand hygiene and social distancing became more widespread, new issues began to emerge - particularly in those who wore spectacles as a means of vision correction. As we began to see routine patients again after the first lockdown had been lifted, many patients visited our clinics for refractive surgery consultations with a primary motivating factor of wanting spectacle independence due to the fogging of their spectacles as a result of wearing a mask. In this article, we report on new emerging issues in eye care due to the widespread use of masks and on the new unmet need in the corneal and cataract refractive surgery fields.

Impact of COVID-19 on keratoconus patients waiting for corneal cross linking.

PURPOSE: Royal College of Ophthalmologist recent guidance recommended delaying cross-linking services during the COVID-19 pandemic. This study investigates the effects of such delays in the delivery of cross-linking services in patients with keratoconus progression. METHODS: Retrospective observational study of 46 patients with keratoconus progression, whose cross-linking was delayed due to the COVID-19 pandemic. Demographic and clinical details were obtained from assessments on the day of listing, and subsequent review on the day of the procedure. Topographic indices included keratometry of the posterior and anterior corneal surface, maximum keratometry (Kmax), thinnest corneal thickness, ABCD progression and progression based on standard criteria recommendations (1.5 D Kmax & 20 microns thinning). RESULTS: A total of 46 eyes were analysed with an average time between being listed for CXL and having the procedure done was 182 ± 65 days. The delay due to COVID-19 was of 3 months. In this time period they had a significant worsening of all keratometric indices and lost almost one line of visual acuity (0.19 ± 0.19 to 0.26 ± 0.18 LogMAR, p: 0.03). Thirty two eyes (70%) demonstrated progression in accordance with the ABCD progression criteria, while 18 eyes (39%) showed either an increase in Kmax of more than 1.5D or a thinning in corneal thickness of at least 20 µm. CONCLUSIONS: The treatment delay for the keratoconus patients caused further progression and vision worsening. We recommend that corneal collagen crosslinking needs to be considered as a high priority intervention.

All India Ophthalmological Society - Preferred practice in refractive surgery during the COVID-19 pandemic.

Coronavirus pandemic has strained the healthcare system with mortality and morbidity. A number of elective surgeries have come to standstill due to lockdown and movement restrictions. Refractive surgery being a purely elective procedure and quite a fresh subset of ophthalmology, there is a lack of unanimity as to what precautions should be followed to resume the practice of same. This article attempts to highlight simple guidelines in accordance with an expert panel, which can be followed by all those involved directly or indirectly in refractive surgery services while addressing safety of doctors, supporting staff as well as patients as a primary concern.