Ophthalmology practice during the COVID-19 pandemic

OBJECTIVE: To present an established practice protocol for safe and effective hospital-setting ophthalmic practice during the coronavirus disease 2019 (COVID-19) pandemic. METHODS AND ANALYSIS: Literature was reviewed to identify articles relevant to COVID-19 pandemic and ophthalmology. The following keywords were used: COVID-19, SARS-CoV-2 and telemedicine, combined with eye, ophthalmology, conjunctivitis and tears. Data were extracted from the identified manuscripts and discussed among subspecialists to obtain consensus evidence-based practice. RESULT(S): A protocol for ophthalmic practice in the era of COVID-19 pandemic was established. The protocol covered patient screening, clinic flow, required personal protective equipment and modifications of ophthalmic equipment for improved safety. CONCLUSION(S): Important literature emerged with respect to the practice of ophthalmology in the era of COVID-19. An evidence-based ophthalmic practice protocol was established and should be modified in the future to accommodate new insights on the COVID-19 pandemic.Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Ophthalmic Emergency Visits in the Wake of the COVID-19 Pandemic: Our Experience at a Tertiary Hospital in Israel

Background: In response to the coronavirus disease-2019 (COVID-19) pandemic, routine clinical visits to the ophthalmic emergency department (OED) were deferred, while emergency cases continued to be seen. Objectives: To assess the consequences of the COVID-19 pandemic for ophthalmic emergencies. Methods: A retrospective chart analysis of patients who presented to the OED during the peak of the COVID-19 pandemic was conducted. The proportions of traumatic, non-traumatic-urgent, and non-traumatic-non-urgent presentations in 2020 were compared to those of the same time period in 2019. Duration of chief complains and best-corrected visual acuity were also assessed. Results: There were 144 OED visits in 2020 compared to 327 OED visits during the same 3-week-period in 2019. Lower mean age of OED patients was present in 2020. Logarithmic expression (LogMAR) best corrected visual acuity (BVCA) was similar in both years. In 2020 there was a reduction in traumatic, non-traumatic-urgent, and non-traumatic-non-urgent cases compared to 2019 (15.4% reduction, P= 0.038;57.6% reduction, P= 0.002;74.6% reduction, P= 0.005, respectively). There was a higher proportion of same-day presentations at commencement of symptoms in 2020 compared with 2019 (52.8% vs. 38.8%, respectively P= 0.006). Conclusions: During the COVID-19 pandemic, the number of OED visits at a tertiary hospital dropped by more than half. Although the drop in visits was mostly due to decrease in non-traumatic-non-urgent cases, there was also decrease in non-traumatic-urgent presentations with possible important visual consequences. Additional studies should elucidate what happened to these patients.

Safety margins of anti-VEGF therapy using treat and extend treatment protocol-lessons from the COVID-19 pandemic

Purpose : To analyze the consequences of delaying intravitreal (IVI) anti-vascular endothelial growth factor (VEGF) therapy in patients under treat-and-extend (TAE) protocol. Methods : A retrospective review of medical records of a consecutive group of patients receiving IVI using TAE protocol before and during the COVID-19 pandemic. Data collected included diagnosis, demographics, treatment schedule, compound used and anatomical outcome according to spectral-domain optical coherence tomography (SD-OCT). Results : A total of 923 eyes (691 patients) were included;58.8% (543 eyes) were treated for neovascular age-related macular degeneration (nvAMD), 25% (231 eyes) had diabetic macular edema (DME), and 16.2% (149 eyes) with retinal vein occlusion (RVO). The average patient age (±SD) was 74.5 ± 11.7 years. The Female/male ratio was 1.08:1. Delayed therapy during the pandemic (?7 days) occurred in 56.3% of the eyes. This included 56.2%, 61.5%, 49.0% of nvAMD, DME and RVO patients respectively. The overall average delay (±SD) was 15.3±23.4 days. RVO patients were on average less late (9.3±16.1 days) compared to nvAMD (15.8±23.8) and DME (18.2±25.6) eyes (P=0.002). Multivariate analysis showed that in nvAMD duration of the disease and type of anti-VEGF were predictors of the number of days late (P=0.011 and 0.019). In eyes ? 7days late, 45.7%, 58.5%, and 58.9% of nvAMD, DME, and RVO eyes respectively showed an increase in central subfield thickness (CST). Worsening was related to absolute numbers of days late, and not to the percentage of delay of the recommended interval. A positive correlation was found between delay to treatment and an increase in CST. Conclusions : Delaying IVI in eyes under TAE regimen was common during the COVID-19 pandemic. These delays were associated with macular thickening having potential visual consequences.