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1.
Am J Ophthalmol ; 241: 262-271, 2022 09.
Article in English | MEDLINE | ID: covidwho-2014767

ABSTRACT

PURPOSE: To assess safety of gene therapy in G11778A Leber hereditary optic neuropathy (LHON). DESIGN: Phase 1 clinical trial. METHODS: Setting: single institution. PARTICIPANTS: Patients with G11778A LHON and chronic bilateral visual loss >12 months (group 1, n = 11), acute bilateral visual loss <12 months (group 2, n = 9), or unilateral visual loss (group 3, n = 8). INTERVENTION: unilateral intravitreal AAV2(Y444,500,730F)-P1ND4v2 injection with low, medium, high, and higher doses to worse eye for groups 1 and 2 and better eye for group 3. OUTCOME MEASURES: Best-corrected visual acuity (BCVA), adverse events, and vector antibody responses. Mean follow-up was 24 months (range, 12-36 months); BCVAs were compared with a published prospective natural history cohort with designated surrogate study and fellow eyes. RESULTS: Incident uveitis (8 of 28, 29%), the only vector-related adverse event, resulted in no attributable vision sequelae and was related to vector dose: 5 of 7 (71%) higher-dose eyes vs 3 of 21 (14%) low-, medium-, or high-dose eyes (P < .001). Incident uveitis requiring treatment was associated with increased serum AAV2 neutralizing antibody titers (p=0.007) but not serum AAV2 polymerase chain reaction. Improvements of ≥15-letter BCVA occurred in some treated and fellow eyes of groups 1 and 2 and some surrogate study and fellow eyes of natural history subjects. All study eyes (BCVA ≥20/40) in group 3 lost ≥15 letters within the first year despite treatment. CONCLUSIONS: G11778A LHON gene therapy has a favorable safety profile. Our results suggest that if there is an efficacy effect, it is likely small and not dose related. Demonstration of efficacy requires randomization of patients to a group not receiving vector in either eye.


Subject(s)
Optic Atrophy, Hereditary, Leber , DNA, Mitochondrial/genetics , Dependovirus/genetics , Dependovirus/metabolism , Electroretinography , Genetic Therapy/adverse effects , Genetic Therapy/methods , Genetic Vectors , Humans , NADH Dehydrogenase/genetics , NADH Dehydrogenase/metabolism , Optic Atrophy, Hereditary, Leber/genetics , Optic Atrophy, Hereditary, Leber/therapy , Prospective Studies , Retinal Ganglion Cells , Tomography, Optical Coherence , Vision Disorders/etiology , Visual Acuity , Visual Fields
2.
Ocul Immunol Inflamm ; 30(5): 1255-1259, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1784143

ABSTRACT

PURPOSE: To report a case of transient visual field (VF) defect after coronavirus disease-19 (COVID-19) vaccination. CASE REPORT: A 38-year-old Caucasian, otherwise healthy female patient, presented with a complaint of vision loss in the outer quadrant in her left eye after the second dose of Pfizer®-BioNTech™ COVID-19 vaccine. The Snellen visual acuity was 20/20 in both eyes. She did not have relative afferent pupillary defect nor disturbance of color vision. Her intraocular pressures, slit lamp and fundus examinations were normal. In the VF test, a temporal hemifield defect in the left eye and a nasal peripheral VF defect in the right eye were detected. Other imaging characteristics and neurological examination were normal. She was followed without any treatment. One week later, the patient was re-evaluated and complete resolution of the VF defect was observed. CONCLUSION: Clinicians should be aware that patients can experience transient visual symptoms following COVID-19 vaccination.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Vision Disorders/diagnosis , Vision Disorders/etiology , Visual Field Tests , Visual Fields
3.
J Neuroophthalmol ; 41(3): 351-355, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1367099

ABSTRACT

ABSTRACT: A 47-year-old man with a history of COVID-19 infection 2 months before presentation, presented with a scotoma of the paracentral visual field of the right eye. After thorough testing and evaluation, a diagnosis of paracentral acute middle maculopathy (PAMM) was established. Two months later, the patient developed temporal headache and jaw claudication. High-dose steroids were initiated, and workup for giant cell arteritis (GCA) was undertaken. The patient experienced resolution of the symptoms within 24 hours of steroid initiation. ESR, CRP, and temporal artery biopsy results were normal, although all were obtained more than 2 weeks after steroid initiation. To the best of our knowledge, our patient represents the first individual to date to potentially implicate COVID-19 in both small and large vessel vasculitis in the ophthalmic setting.


Subject(s)
COVID-19/complications , Giant Cell Arteritis/etiology , Macular Degeneration/etiology , Visual Fields/physiology , Acute Disease , Biopsy , COVID-19/epidemiology , Giant Cell Arteritis/diagnosis , Humans , Macular Degeneration/diagnosis , Male , Middle Aged , SARS-CoV-2
4.
J Glaucoma ; 30(10): 878-881, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1356729

ABSTRACT

PRECIS: Tape sealing of the face mask can prevent fogging artifacts of visual field testing. Here, we demonstrate that tape sealing can improve visual field scores even when fogging artifacts are not obvious. PURPOSE: The purpose of this study was to demonstrate that visual field scores improve when the face masks are taped to prevent fogging artifacts. METHODS: A Single-center, randomized 2×2 cross-over study. Twenty-six visual fields of 13 patients of the glaucoma outpatient clinic were included. Patients were randomized in either sequence 1 (Octopus visual field examination without tape sealing, followed by examination with tape sealing) or sequence 2 (examination with, followed by without tape sealing). RESULTS: The results for mean defect and square root of loss variance differ significantly in the examination with and without tape sealing [mean difference (without-with) 0.39 dB, 95% confidence interval: 0.07-0.70 dB, P=0.018 and 0.49 dB, 95% confidence interval: 0.19-0.79 dB, P=0.003, respectively]. There was no sequence effect (P=0.967) for mean defect nor the square root of loss variance (P=0.779). A significant effect for period (P=0.023) for mean defect was yielded. CONCLUSION: Tape sealing of face masks during visual field testing prevented fogging artifacts and improved visual field scores even when fogging artifacts were not obvious and should be considered in clinical practice.


Subject(s)
COVID-19 , Visual Fields , Cross-Over Studies , Humans , Intraocular Pressure , Masks , SARS-CoV-2 , Visual Field Tests
6.
PLoS One ; 16(6): e0253067, 2021.
Article in English | MEDLINE | ID: covidwho-1280622

ABSTRACT

Modern accounts of visual motion processing in the primate brain emphasize a hierarchy of different regions within the dorsal visual pathway, especially primary visual cortex (V1) and the middle temporal area (MT). However, recent studies have called the idea of a processing pipeline with fixed contributions to motion perception from each area into doubt. Instead, the role that each area plays appears to depend on properties of the stimulus as well as perceptual history. We propose to test this hypothesis in human subjects by comparing motion perception of two commonly used stimulus types: drifting sinusoidal gratings (DSGs) and random dot patterns (RDPs). To avoid potential biases in our approach we are pre-registering our study. We will compare the effects of size and contrast levels on the perception of the direction of motion for DSGs and RDPs. In addition, based on intriguing results in a pilot study, we will also explore the effects of a post-stimulus mask. Our approach will offer valuable insights into how motion is processed by the visual system and guide further behavioral and neurophysiological research.


Subject(s)
Motion Perception/physiology , Neurons/physiology , Photic Stimulation/methods , Visual Cortex/physiology , Visual Fields/physiology , Visual Pathways/physiology , Visual Perception/physiology , Humans
7.
Inflamm Res ; 70(9): 931-933, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1258184

ABSTRACT

Long-term and rare adverse effects of COVID-19 vaccines are unknown. Hence, it is important to report them to improve the safety profile of the vaccines and enhance their use worldwide. Here, we describe a case of acute visual impairment after Pfizer-BioNTech vaccine second dose.


Subject(s)
COVID-19 Vaccines/adverse effects , Vision Disorders/etiology , Visual Acuity/drug effects , Visual Fields , Humans , Male , Middle Aged , Vaccination/adverse effects
8.
Am J Ophthalmol ; 227: 222-230, 2021 07.
Article in English | MEDLINE | ID: covidwho-1252395

ABSTRACT

PURPOSE: The purpose of this study was to determine if a mobile application, the Checkup Vision Assessment System, could reliably monitor visual acuity (VA) and metamorphopsia remotely versus standard VA reference tests in the clinic. With the current COVID-19 pandemic, an even greater need for remote monitoring exists. Mobile tools enhance the ability to monitor patients virtually by enabling remote monitoring of VA and Amsler grid findings. DESIGN: Prospective, multicenter reliability analysis. METHODS: Participants: Patients (N = 108) with near corrected VA better than 20/200 and a diagnosis of age-related macular degeneration, diabetic retinopathy, or healthy patients without retinal disease (best-corrected visual acuity [BCVA] of 20/32 or better). INTERVENTION: participants were tested using the Checkup, reference VA, and Amsler tests, with the order of testing (Checkup or reference) randomized. Patients monitored their vision using Checkup at least twice a week at home between office visits. Main outcome measurements were near corrected VA and Amsler grid test results. RESULTS: Agreement was strong between Checkup and reference tests for VA (r = 0.86) and Amsler grid (sensitivity: 93%; specificity: 92%). Home versus clinic testing showed excellent agreement (r = 0.96). Patients reported successful home use. There were no serious adverse events or discontinuations. Patients rated the usability of Checkup to be excellent. CONCLUSIONS: There was good agreement between Checkup and in-clinic test results for VA and Amsler grid. The low variance of Checkup testing, agreement between in-clinic and home results, and excellent usability support Checkup as a reliable method for monitoring retinal pathology in clinic and home settings.


Subject(s)
COVID-19/epidemiology , Diabetic Retinopathy/physiopathology , Macular Degeneration/physiopathology , Mobile Applications , Monitoring, Physiologic/methods , Visual Acuity , Visual Fields/physiology , Aged , Comorbidity , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/epidemiology , Female , Humans , Macular Degeneration/diagnosis , Macular Degeneration/epidemiology , Male , Middle Aged , Pandemics , Prospective Studies , Reproducibility of Results , SARS-CoV-2
9.
PLoS One ; 16(5): e0251201, 2021.
Article in English | MEDLINE | ID: covidwho-1226894

ABSTRACT

BACKGROUND: Mouth-nose masks have been requested to prevent the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The aim of the present study was to investigate, if wearing a mouth-nose mask impairs the visual field function in normals. METHODS: Thirty eyes of 30 subjects were recruited for the present study. White-on-white perimetry (OCTOPUS 900; 90°) was done and sensitivity was analysed in 14 defined test points (P1-P14, inferior visual field) under 3 different test conditions while the subjects were wearing a mouth-nose mask: (I) 1.5 cm under the lower eyelid, nose clip not used (position1.5cm_no_clip); (II) 1.5 cm under the lower eyelid, nose clip correctly positioned (position1.5cm_with_clip); (III) 0.5 cm under the lower eyelid, nose clip correctly positioned (position0.5cm_with_clip). All data were compared to sensitivity without wearing a mouth-nose mask (reference). Mean Δ was calculated, being the difference between the results of each test condition and reference, respectively. RESULTS: Sensitivity was significantly different between position1.5cm_no_clip and reference at 10 test points (p<0.05). Sensitivity at test point P7 was significantly different between position1.5cm_with_clip and position0.5cm_with_clip compared to reference (p<0.001), respectively. Mean Δ increased while wearing a mask at P7: position1.5cm_with_clip (-8.3 dB ± 7.3 dB) < position0.5cm_with_clip (-11.3 dB ± 9.5 dB) < position1.5cm_no_clip (-20.1 dB ± 7.6 dB). CONCLUSION: Visual field function was observed to be significantly impaired in the inferior-nasal sector while persons were wearing a mouth-nose mask, especially when the nose clip was not correctly used.


Subject(s)
Masks , Visual Fields , Adult , COVID-19/prevention & control , Female , Humans , Male , SARS-CoV-2/isolation & purification , Vision Tests , Vision, Ocular , Young Adult
10.
BMJ Open ; 11(4): e043130, 2021 04 05.
Article in English | MEDLINE | ID: covidwho-1169874

ABSTRACT

OBJECTIVES: To explore the acceptability of home visual field (VF) testing using Eyecatcher among people with glaucoma participating in a 6-month home monitoring pilot study. DESIGN: Qualitative study using face-to-face semistructured interviews. Transcripts were analysed using thematic analysis. SETTING: Participants were recruited in the UK through an advertisement in the International Glaucoma Association (now Glaucoma UK) newsletter. PARTICIPANTS: Twenty adults (10 women; median age: 71 years) with a diagnosis of glaucoma were recruited (including open angle and normal tension glaucoma; mean deviation=2.5 to -29.9 dB). RESULTS: All participants could successfully perform VF testing at home. Interview data were coded into four overarching themes regarding experiences of undertaking VF home monitoring and attitudes towards its wider implementation in healthcare: (1) comparisons between Eyecatcher and Humphrey Field Analyser (HFA); (2) capability using Eyecatcher; (3) practicalities for effective wider scale implementation; (4) motivations for home monitoring. CONCLUSIONS: Participants identified a broad range of benefits to VF home monitoring and discussed areas for service improvement. Eyecatcher was compared positively with conventional VF testing using HFA. Home monitoring may be acceptable to at least a subset of people with glaucoma.


Subject(s)
Glaucoma , Visual Field Tests , Adult , Aged , Female , Glaucoma/diagnosis , Humans , Intraocular Pressure , Pilot Projects , Qualitative Research , Vision Disorders/diagnosis , Visual Fields
11.
Am J Ophthalmol ; 227: 53-65, 2021 07.
Article in English | MEDLINE | ID: covidwho-1157089

ABSTRACT

PURPOSE: TO assess perceptions and implications of COVID-19 infection across the spectrum of individuals with visually impairment (VI) and those with normal sight. DESIGN: Prospective cross-sectional comparative study. METHODS: Setting: institutional. PATIENTS: 232 patients and their caregivers. Four groups were created based on better eye characteristics: blind (best-corrected distance visual acuity [BCDVA] <3/60 or visual field <10 central degrees); severe VI (BCDVA ≤3/60 to <6/60; vertical cup-to-disc ratio ≥0.85 or neuroretinal rim width ≤0.1); moderate VI (BCDVA ≤6/60 to <6/18); or no or mild VI (controls: BCDVA ≥6/18) based on International Classification of Diseases-10 criteria and Foster and Quigley's consensus definition of glaucoma. PROCEDURE: telephone questionnaires. MAIN OUTCOME MEASURES: differences in perceptions and implications of COVID-19 infection across various levels of VI. Caregiver perceptions were a secondary outcome measure. RESULTS: Surveys were completed by 232 participants, with 58 participants in each VI group. Mean age was 58.9 ± 13.2 years old. Greater degrees of VI were associated with older age (P = .008) and lower education level (P = .046). Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 (P = .045), were concerned about access to health care (P <.001), obtained news through word of mouth (P <.001), and less commonly wore masks (P = .003). Controls more commonly performed frequent handwashing (P = .001), were aware of telemedicine (P = .029), and had fewer concerns about social interactions (P = .020) than groups with substantial VI. All caregivers reported more frequent patient care since the COVID-19 pandemic began. CONCLUSIONS: The pandemic might have had a disproportionate impact on the visually impaired, and evidence-based assessments of COVID-19 health outcomes in this population are warranted.


Subject(s)
COVID-19/epidemiology , Pandemics , Vision, Low/epidemiology , Visual Acuity , Visual Fields/physiology , COVID-19/physiopathology , Comorbidity , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology , Visually Impaired Persons/statistics & numerical data
13.
J Glaucoma ; 30(3): 219-222, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1147202

ABSTRACT

PRECIS: Designing and demonstrating an experiment that shows the risk of airborne transmission of COVID-19 between patients having visual fields analyzed is low. PURPOSE: The aim was to investigate the possibility of airborne transmission of COVID-19 during Humphrey visual field testing in a real-world scenario. METHODS: A particle counter was placed within the bowl of Humphrey visual field analyzer (HFA) before and after turning on the machine to ascertain the effect of the air current produced by the ventilation system on aerosols. A second experiment was run where the particle counter was placed in the bowl and recorded particulates, in the air, as a 24-2 SITA standard was performed by a mock patient and then again immediately after the patient had moved away. We measured aerosol particle counts sized ≤0.3 µm, >0.3≤0.5 µm, >0.5≤1 µm, >1≤2.5 µm, >2.5≤5 µm, and >5≤10 µm. RESULTS: Particulates of all sizes were shown to be significantly reduced within the bowl after turning the machine on, demonstrating that the air current produced by the HFA pushes air out of the bowl and it cannot stagnate. There was no significant difference in measurement of aerosol while there was a patient performing the test and immediately after they had moved away, suggesting that aerosols breathed out by the patient are not able to remain in suspension in the bowl because of the ventilation current. CONCLUSION: There is no significant difference between aerosol count in the bowl of a HFA before, during and after testing. This suggests the risk of airborne transmission of COVID-19 is low between subsequent patients. This is in keeping with manufacturer's guidance on Humphrey visual field testing.


Subject(s)
Aerosols/adverse effects , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Ocular Hypertension/diagnosis , Visual Field Tests/methods , Visual Fields/physiology , COVID-19/epidemiology , Comorbidity , Humans , Intraocular Pressure/physiology , Ocular Hypertension/epidemiology , Ocular Hypertension/physiopathology , SARS-CoV-2
14.
Shock ; 55(4): 472-478, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1140043

ABSTRACT

INTRODUCTION: Since December 2019, the novel coronavirus SARS-CoV-2 has been spreading worldwide. Since the main route of infection with SARS-CoV-2 is probably via contact with virus-containing droplets of the exhaled air, any method of securing the airway is of extremely high risk for the health care professionals involved. We evaluated the aerosol exposure to the interventional team during a tracheotomy in a semiquantitative fashion. In addition, we present novel protective measures. PATIENTS AND METHODS: To visualize the air movements occurring during a tracheotomy, we used a breathing simulator filled with artificial fog. Normal breathing and coughing were simulated under surgery. The speed of aerosol propagation and particle density in the direct visual field of the surgeon were evaluated. RESULTS: Laminar air flow (LAF) in the OR reduced significantly the aerosol exposure during tracheostomy. Only 4.8 ±â€Š3.4% of the aerosol was in contact with the surgeon. Without LAF, however, the aerosol density in the inspiratory area of the surgeon is 10 times higher (47.9 ±â€Š10.8%, P < 0.01). Coughing through the opened trachea exposed the surgeon within 400 ms with 76.0 ±â€Š8.0% of the aerosol-independent of the function of the LAF. Only when a blocked tube was inserted into the airway, no aerosol leakage could be detected. DISCUSSION: Coughing and expiration during a surgical tracheotomy expose the surgical team considerably to airway aerosols. This is potentially associated with an increased risk for employees being infected by airborne-transmitted pathogens. Laminar airflow in an operating room leads to a significant reduction in the aerosol exposure of the surgeon and is therefore preferable to a bedside tracheotomy in terms of infection prevention. Ideal protection of medical staff is achieved when the procedure is performed under endotracheal intubation and muscle relaxation.


Subject(s)
Aerosols , COVID-19/transmission , Occupational Diseases/etiology , Occupational Exposure , Surgeons , Tracheotomy , Cough/complications , Environment, Controlled , Humans , Operating Rooms , Patient Simulation , Point-of-Care Systems , Respiration , Risk , Virion , Visual Fields
15.
Indian J Ophthalmol ; 69(4): 989-991, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1138825

ABSTRACT

Ocular manifestations of COVID-19 are still being studied. Posterior segment involvement in viral entities is either direct viral involvement or a delayed immune response to the antigen. A 22-year-old woman presented with history of perceiving absolute inferior scotoma in the right eye for 4 days and history of fever and sore throat 10 days ago. Fundus examination revealed disc edema and vessel tortuosity. Humphreys Field Analyzer confirmed inferior field defect and Optical Coherence Tomography showed superior, nasal and inferior retinal nerve fiber layer thickening in the right eye. Patient was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) testing. Patient received three doses of injection methylprednisolone over 3 days. There was subjective resolution of scotoma reported 3 weeks posttreatment. We bring forward the first reported case of parainfectious optic neuritis associated with COVID-19.


Subject(s)
COVID-19/diagnosis , Eye Infections, Viral/diagnosis , Papilledema/diagnosis , SARS-CoV-2 , Scotoma/diagnosis , Visual Fields/physiology , COVID-19/drug therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Glucocorticoids/therapeutic use , Humans , Methylprednisolone/therapeutic use , Papilledema/drug therapy , Papilledema/virology , Scotoma/drug therapy , Scotoma/virology , Tomography, Optical Coherence , Visual Acuity , Visual Field Tests , Young Adult
16.
J Glaucoma ; 30(4): 287-292, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1066454

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) spread rapidly worldwide, causing a severe outbreak. Because the disease is easily transmitted, face masks are a vital tool to slow the spread. The aim of this study is to investigate the impacts of face mask use on standard automated perimetry (SAP) results in glaucoma patients. MATERIALS AND METHODS: All follow-up glaucoma patients who underwent SAP between May and October 2020 were enrolled in this study. In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients' face masks. RESULTS: A total of 127 patients (59 female and 68 male) with a mean age of 59.8±10.3 years were included in the study. While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks. Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in 3 patients (2.4%). The main effects of poorly fitting face masks on SAP reliability were increased fixation losses and false-positive errors (for both, P=0.001). Low SAP reliability was significantly higher in patients wearing cloth face masks than in those wearing surgical face masks (47.8% vs. 9.9%; P=0.0001). The face mask-related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses-related low SAP reliability (odds ratio: 27, 95% confidence interval: 5.48-132.92, P=0.0001). In all repeated SAPs, the patients' reliability parameters improved, and inferior visual field artifacts disappeared. CONCLUSIONS: Unsuitable face masks can cause either visual field artifacts, which may be interpreted as glaucoma progression or low test reliability. Taping the face masks' upper edges is an effective technique to prevent visual field artifacts and obtain good test reliability.


Subject(s)
Glaucoma/diagnosis , Intraocular Pressure , Masks/adverse effects , Visual Field Tests/adverse effects , Visual Field Tests/methods , Aged , Artifacts , COVID-19/epidemiology , Electronic Data Processing , Female , Humans , Male , Middle Aged , Prospective Studies , Reference Standards , Reproducibility of Results , Visual Fields
17.
J Neurol Phys Ther ; 45(1): 36-40, 2021 01.
Article in English | MEDLINE | ID: covidwho-1035551

ABSTRACT

Individuals with balance and gait problems encounter additional challenges navigating this post-coronavirus disease-2019 (COVID-19) world. All but the best fitting facemasks partially obscure the lower visual field. Facemask use by individuals with balance and gait problems has the potential to further compromise walking safety. More broadly, as the world reopens for business, balance and gait testing in clinics and research laboratories will also be impacted by facemask use. Here, we highlight some of the challenges faced by patients, clinicians, and researchers as they return to "normal" after COVID-19.Video Abstract is available for insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A328).


Subject(s)
COVID-19/prevention & control , Gait Disorders, Neurologic , Masks/adverse effects , N95 Respirators/adverse effects , Postural Balance , Spatial Navigation , Visual Fields , Aged , Female , Gait Disorders, Neurologic/physiopathology , Humans , Male , Middle Aged , Postural Balance/physiology , Spatial Navigation/physiology , Visual Fields/physiology
18.
Anesthesiology ; 134(4): 518-525, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1010655

ABSTRACT

Clinicians who care for patients infected with coronavirus disease 2019 (COVID-19) must wear a full suite of personal protective equipment, including an N95 mask or powered air purifying respirator, eye protection, a fluid-impermeable gown, and gloves. This combination of personal protective equipment may cause increased work of breathing, reduced field of vision, muffled speech, difficulty hearing, and heat stress. These effects are not caused by individual weakness; they are normal and expected reactions that any person will have when exposed to an unusual environment. The physiologic and psychologic challenges imposed by personal protective equipment may have multiple causes, but immediate countermeasures and long-term mitigation strategies can help to improve a clinician's ability to provide care. Ultimately, a systematic approach to the design and integration of personal protective equipment is needed to improve the safety of patients and clinicians.


Subject(s)
COVID-19/prevention & control , Health Personnel/statistics & numerical data , Personal Protective Equipment/adverse effects , Work Performance/statistics & numerical data , Equipment Design , Hearing , Heat-Shock Response , Humans , SARS-CoV-2 , Speech , Visual Fields , Work of Breathing
19.
Neurosurg Focus ; 49(6): E15, 2020 12.
Article in English | MEDLINE | ID: covidwho-954715

ABSTRACT

OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, neurosurgeons all around the globe continue to operate in emergency cases using new self-protective measures. Personal protective equipment (PPE) use is recommended in all surgeries. The authors have experienced varying degrees of field of view (FOV) loss under the surgical microscope with different PPE. Herein, they aimed to investigate the effects of different PPE on FOV while using the surgical microscope. METHODS: Fifteen neurosurgeons and neurosurgery residents participated in this study. Three kinds of PPE (safety spectacles, blast goggles, and face shields) were tested while using a surgical microscope. FOV was measured using a 12 × 12-cm checkered sheet of paper on which every square had an area of 25 mm2 under the microscope. The surgical microscope was positioned perpendicular to the test paper, and the zoom was fixed. Each participant marked on the test sheet the peripheral borders of their FOV while using different PPE and without wearing any PPE. A one-way repeated-measures ANOVA was performed to determine if there was a significant difference in FOV values with the different PPE. RESULTS: FOV was significantly different between each PPE (F[3, 42] = 6339.845, p < 0.0005). Post hoc analysis revealed a significant decrease in the FOV from the naked eye (9305.33 ± 406.1 mm2) to blast goggles (2501.91 ± 176.5 mm2) and face shields (92.33 ± 6.4 mm2). There were no significant FOV changes with the safety spectacles (9267.45 ± 410.5 mm2). CONCLUSIONS: While operating under a surgical microscope safety spectacles provide favorable FOVs. Face shields increase the eye piece-pupil distance, which causes a severe reduction in FOV.


Subject(s)
COVID-19/prevention & control , Microsurgery/trends , Neurosurgeons/trends , Neurosurgical Procedures/trends , Personal Protective Equipment/trends , Visual Fields , COVID-19/transmission , Humans , Microscopy/instrumentation , Microscopy/trends , Microsurgery/instrumentation , Neurosurgical Procedures/instrumentation , Personal Protective Equipment/adverse effects , Visual Fields/physiology
20.
Otol Neurotol ; 42(4): 606-613, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-913295

ABSTRACT

BACKGROUND: During the Covid-19 pandemic, otolaryngologists are at risk due to aerosol-generating procedures such as mastoidectomy and need enhanced personal protective equipment (PPE). Eye protection can interfere with the use of a microscope due to a reduction in the field of vision. We aimed to study the effect of PPE on the microsurgical field. METHODS: Five surgeons measured the visual field using digital calipers at different power settings. They were done with no PPE, a surgical mask, FFP3 mask (N99), and with the addition of small goggles, large vistamax goggles, vistamax plus a face shield, and only a face shield. The measurements were repeated with rings of 5 mm increments. We also measured the "eye relief" of the microscope which is the ideal distance for maximum field of view. RESULTS: There was no major reduction of the field with the surgical or FFP3 mask. But even simple goggles reduced the field up to 31.6% and there were progressive reductions of up to 75.7% with large goggles, 76.8% when a face shield was added, and 61.9% when only face shield was used. The distance rings more than 5 mm also affected the field of view.The eye relief of our eyepiece was found to be 15 mm. CONCLUSION: The current PPE eye protection is not compatible with the use of a microscope. There is scope for research into better eye protection. Mitigation strategies including barrier drapes and alternative techniques such as endoscopic surgery or use of exoscopes should also be considered.


Subject(s)
COVID-19/prevention & control , Microsurgery , Otolaryngologists , Personal Protective Equipment/adverse effects , Visual Fields , COVID-19/transmission , Humans , Mastoidectomy/adverse effects , Microsurgery/instrumentation , Microsurgery/methods , SARS-CoV-2
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