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1.
Eur J Ophthalmol ; 32(4): 2445-2451, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1354692

ABSTRACT

OBJECTIVE: To assess the patterns of patient generated aerosol in the context of ophthalmic surgery and ophthalmic examinations. To inform medical teams regarding potential hazards and suggest mitigating measures. METHODS: Qualitatively, real-time time videography assessed exhalation patterns from simulated patients under different clinical scenarios using propylene glycol from an e-cigarette. Quantitatively, high-speed Schlieren imaging was performed to enable high resolution recordings analysable by MATLAB technical computing software. RESULTS: Without a face mask, the standard prior to COVID 19, vapour was observed exiting through the opening in the drape over the surgical field. The amount of vapour increased when a surgical mask was worn. With a taped face mask, the amount of vapour decreased and with inclusion of a continuous suction device, the least amount of vapour was seen. These results were equivocal when the patient was supine or sitting upright. High-speed Schlieren imaging corroborated these findings and in addition showed substantial increase in airflow egress during coughing and with ill-fitting face masks. CONCLUSION: Advising patients to wear a surgical mask at the time of ophthalmic interventions potentially contaminants the ocular field with patient generated aerosol risking endophthalmitis. Surgeon safety can be maintained with personal protective equipment to mitigate the increased egress of vapour from the surgical drape and taping, with or without suction is advisable, whilst meticulous hygiene around lenses is required at the time of slit lamp examination.


Subject(s)
COVID-19 , Electronic Nicotine Delivery Systems , Endophthalmitis , Aerosols , COVID-19/prevention & control , Endophthalmitis/surgery , Humans , Personal Protective Equipment
2.
Eur J Ophthalmol ; 32(3): 1390-1397, 2022 May.
Article in English | MEDLINE | ID: covidwho-1305548

ABSTRACT

OBJECTIVES: The coronavirus pandemic has forced healthcare staff across all medical specialties to adapt new and different ways of working. A new approach has been set up in the Acute Referral Clinic (ARC) at Musgrove Park Hospital and a survey has been conducted to measure the impact of the new method on patient and healthcare professionals' satisfaction with the new service. METHODS: A telephone-based consultation was introduced in ARC at Musgrove Park Hospital in March 2020 and patients were instructed to fill out a questionnaire containing eight items using a Likert Scale 1 ('very poor/disagree') to 4 ('very good/strongly agree') plus two boxes for open positive and negative comments respectively. Likewise a questionnaire was designed in order to assess the healthcare professionals' satisfaction using the new approach. Data collection took place over a two month period between the end of March 2020 and end of May 2020. The data underwent quality control and was analysed using descriptive statistics. RESULTS: Patient responses illustrated high satisfaction scores with an overall rating of very good (89.4%). The healthcare professionals' rating of the service was good (28.6% - 'very good/strongly agree', 57.1% - 'good/agree'). The safety rating of the new approach was overall rated 'very good' with 90.4% and 71.4% of patients and healthcare professionals respectively. CONCLUSIONS: The telephone consultations introduced in the wake of COVID-19 are well accepted by both patients and doctors. There are some limitations of the approach, foremost being consultation time and clinic space but these do not outweigh the general benefit of this format amidst a pandemic setting.


Subject(s)
COVID-19 , Telemedicine , COVID-19/epidemiology , Humans , Patient Satisfaction , Referral and Consultation , Surveys and Questionnaires , Telemedicine/methods , Telephone
3.
Eur J Ophthalmol ; 31(2): 807-816, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-992310

ABSTRACT

PURPOSE: To describe the immediate consequences of SARS-CoV-2 and the COVID-19 pandemic on the ocular surface and eye-care professionals, and to discuss the need for a mandatory switch from currently performed tele-screening to true teleconsultation for remote ocular surface assessment. MAIN FINDINGS: Ophthalmologists have been largely impacted by the COVID-19 sanitary crisis, due to both the ocular manifestations of SARS-CoV-2 and to the high contagiousness of the virus. The proximity of ophthalmologists to their patients have pushed eye-care providers to readapt their practices and develop alternatives to face-to-face consultations. However, teleconsultation has some major limitations and drawbacks, especially for ocular surface assessment that relies on high-quality graphic data for adequate diagnosis. Tele-screening, on the other hand, emphasizes on the importance of history-taking and listening to the patient in order to adequately prioritize appointments based on the presumed degree of emergency. CONCLUSION: Despite all the enthusiasm, tele-screening as currently performed with the available tools is still not capable of completely replacing a standard ophthalmic examination for the assessment of ocular surface diseases. While waiting for new emerging technologies and future implementation of imaging modalities and artificial intelligence, decision making algorithms can help eye-practitioners remotely screen their patients to assess the optimal time for follow-up appointments.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/methods , Conjunctival Diseases/diagnosis , Corneal Diseases/diagnosis , Delivery of Health Care/trends , Dry Eye Syndromes/diagnosis , SARS-CoV-2 , Health Personnel , Humans , Ophthalmology/trends , Physical Examination/methods , Telemedicine/methods
4.
Eur J Ophthalmol ; 31(2): 321-327, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-939985

ABSTRACT

The COVID-19 pandemic has altered the clinical landscape immeasurably. The need to physical distance requires rethinking how we deliver ophthalmic care. Within healthcare, we will need to focus our resources on the five T's: Utilising technology, multidisciplinary clinical teams with wide professional talents need to work efficiently to reduce patient contact time. With regular testing, this will allow us to reduce the risk further. We also must acknowledge the explosion of different modalities to train our future ophthalmologists and the global challenges and advantages that these bring. Finally, we must not forget the psychological impact that this pandemic will have on ophthalmologists and ancillary staff, and need to have robust mechanisms for support.


Subject(s)
COVID-19/transmission , Communicable Disease Control/methods , Delivery of Health Care/organization & administration , Health Plan Implementation/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Ophthalmology/organization & administration , SARS-CoV-2 , Humans , Telemedicine/methods
5.
Eur J Ophthalmol ; 31(1): 10-12, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-791664

ABSTRACT

We report our experience during COVID-19 outbreak for intravitreal injections in patients with maculopathy. We proposed a treatment priority levels and timings; the "High" priority level includes all monocular patients; the "Moderate" is assigned to all patients with an active macular neovascularization; the patients affected by diabetic macular edema or retinal vein occlusion belong to the "Low" class. This organization allowed us to treat the most urgent patients although the injections performed had a 91.7% drop compared to the same period of 2019.


Subject(s)
COVID-19/epidemiology , Disease Outbreaks , Health Priorities/organization & administration , Pharmaceutical Preparations/administration & dosage , Retinal Diseases/classification , SARS-CoV-2 , Tertiary Care Centers/organization & administration , Central Serous Chorioretinopathy/classification , Central Serous Chorioretinopathy/drug therapy , Diabetic Retinopathy/classification , Diabetic Retinopathy/drug therapy , Humans , Intravitreal Injections , Italy/epidemiology , Macular Degeneration/classification , Macular Degeneration/drug therapy , Macular Edema/classification , Macular Edema/drug therapy , Quarantine , Retinal Diseases/drug therapy , Retinal Vein Occlusion/classification , Retinal Vein Occlusion/drug therapy
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