TFOS lifestyle: Impact of societal challenges on the ocular surface.

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Survey of the Impact of the COVID-19 Pandemic on Ophthalmology Clinical Practice in Turkey

Objectives: To investigate the effect of the novel coronavirus disease 2019 (COVID-19) pandemic on the clinical practice of ophthalmologists in our country. Materials and Methods: A questionnaire consisting of 22 questions was delivered to 250 ophthalmologists via e-mail and a smartphone messaging application. A total of 113 ophthalmologists completed the survey. The questions included the participants' demographic data (age, years in practice, institution, and city), changes in their working conditions and institutional preventive measures implemented during the pandemic, their personal COVID-19 experiences, the prevalence of telemedicine applications, and their attitudes toward these practices. Results: Nearly half (47.8%) of the 113 ophthalmologists were 36 to 45 years old. In terms of years in practice, the largest proportion of respondents (28.3%) had 6-10 years of experience. Most of the participants worked in private/foundation universities (37.2%), while 22.1% worked in education and research clinics. Participants working at public universities most often reported that they or a close contact had to work in COVID wards (89.5%). Triage was performed in 51.5% of ophthalmology outpatient clinics, with 88.0% of these participants reporting that patients with fever, cough, or dyspnea were directed to the pandemic clinic without ophthalmological examination. All participants working in public hospitals, education and research clinics, and public university hospitals had postponed elective surgeries, whereas 12.5% of those working in private practice and 20.5% of those working in private/foundation universities reported that they continued elective surgeries. While 80.8% of the participants did not conduct online interviews or examinations, 40.4% stated that they considered telemedicine applications beneficial. Seventy-seven percent of participants expressed concern about a decrease in their income during the pandemic, with this being especially common among participants working in private practice (87.5%) and private/foundation university hospitals (85.7%). Conclusion: Ophthalmologists across our country have been affected by this pandemic at a level that will change their clinical approach. We think that ophthalmologists impacted by the difficulty of providing personal protective equipment and economic concerns should be supported more during the pandemic.

In Vivo confocal microscopy findings after COVID-19 infection.

PURPOSE: To evaluate clinical and in vivo confocal microscopy (IVCM) findings of a patient who developed multiple unilateral subepithelial stromal opacities following conjunctivitis that developed during a COVID-19 infection. METHODS: A 22-year-old female presented to our clinic with blurred right vision. The history revealed that she had experienced a COVID-19 infection one month ago. Redness and stinging of the right eye had started at the same time and she had been prescribed topical antibiotic drops and ointments. The redness in the right eye had decreased but blurred vision had then developed. RESULTS: Slit lamp examination revealed a normal left eye. Several tiny subepithelial infiltrates without fluorescein staining of the cornea were present in the right eye. The anterior chamber, lens and fundus were bilaterally normal. IVCM revealed irregular corneal epithelial cells with bright borders in addition to scattered inflammatory cells and cell debris in the right eye. There were activated dendritic cells in the subbasal epithelial area with a significant decrease in the subbasal corneal nerve plexus. Clusters of highly reflective cells with an irregular shape were seen in the anterior corneal stroma together with foci of activated keratocytes. The corneal endothelial cell layer was normal. The left eye IVCM findings were all within normal limits. The right eye also showed decreased corneal sensitivity compared to the left. CONCLUSIONS: The possible role of corneal infiltrates as a trigger for COVID-19 could be explained with an immune-mediated mechanism. SARS-CoV-2 can result in decreased corneal sensitivity through corneal nerve involvement. The clinical results of this effect need to be evaluated in larger series.