Per-operative COVID-19 modifications for oculoplastic service: patients perspective and regional review of practice of a protective draping technique.

PURPOSE: COVID-19 has posed problems for oculoplastic surgeons. One issue we felt needed to be addressed was the way patients are draped for surgery. Traditionally patients are draped with their full face exposed, and as a result, aerosols generated from both the patient and surgical team put the other party at risk. METHODS: We created a new draping technique which would create a physical barrier. A regional survey was undertaken to compare regional oculoplastic draping practices with our practice locally in light of the COVID-19 pandemic. A patient satisfaction survey was also completed to understand the impact of our change in practice. RESULTS: Our regional survey generated 22 consultant responses. 36% (8) continued with their normal practice with the full face exposed. 18% (4) of the responders had modified a cataract drape and 45% (10) used a bespoke drape with or without a mask. We started using this modified drape in June 2020 and in the patient survey, 100 percent of patients felt the drape was comfortable and 30% of the patients commented on the relief that they did not have to wear a face mask during surgery. CONCLUSIONS: Our draping technique provides an alternative to the traditional full face exposure draping. It is simple, inexpensive, and readily available. It also addresses and resolves the issue of safety of the oculoplastic surgeon and surgical team whilst maintaining comfort for the patient throughout, particularly when risks the of COVID are ongoing and with the potential of more viruses in the future.

Chapter 3 - Oculoplastic and Orbital Surgery Telehealth

Oculoplastic surgery is uniquely well-positioned within the field of eye care to employ telehealth due to the largely external nature of the conditions treated. Prior to the COVID-19 pandemic, however, telehealth was seldom used in this subspecialty. The year 2020 saw a rapid increase in the use of telehealth by oculoplastic surgeons, particularly synchronous home-based video telehealth. The technology has been most popular for post-operative visits, though surgeons have advocated for its use for various other visit types as well. Oculoplastic surgery societies have advised in favor of using telehealth, but consensus within the field for how it is best used is lacking. This chapter introduces best practices for telehealth visit types and examination techniques for oculoplastic surgeons and suggests directions for future study.

Oculoplastic fellow education during the COVID-19 crisis.

PURPOSE: In March 2020, the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) advised the suspension of all non-emergent oculofacial patient care, imparting unprecedented interruptions in fellowship training. METHODS: ASOPRS fellows and program directors were asked to complete an anonymous survey regarding their perceived impact of the COVID-19 crisis. RESULTS: Forty ASOPRS fellows (70.2%) participated, including 20 first-year and 20 second-year trainees, from all country regions. During the social distancing restrictions, 100% of fellows continued to participate in surgical procedures, including orbital biopsy (77.5%), abscess drainage (55.0%), fracture repair (45.6%), eyelid lesion excision (70.0%) and temporal artery biopsy (57.5%). ASOPRS fellows evaluated patients, including in emergency room (84.6%) and inpatient hospital (76.9%) settings, wearing surgical (85.0%) or N-95 (40.0%) masks, gloves (80.0%) and eye protection (62.5%).Most ASOPRS fellows (87.5%) participated in virtual interinstitutional education sessions and indicated a desire to continue this curriculum. Fellows also used available time for research (85.0%), independent study (77.5%), personal health (70.0%) and social interaction (60.0%).ASOPRS fellows reported COVID-19 restrictions to have a mild (72.5%) to moderate (27.5%) impact on their overall training, and most (75.0%) felt their surgical confidence to decline. Fellowship program directors also asserted a mild (72.2%), moderate (19.4%) or significant (5.6%) impact on subspecialty training, and 94.4% predict adverse effects on graduation case logs. CONCLUSIONS: During the COVID-19 restrictions most ASOPRS fellows participated in emergent clinical activities and novel telemedicine curriculum. Most fellows and program directors expressed concern regarding a negative impact on overall subspecialty education and surgical confidence.

European Society of Ophthalmic Plastic and Reconstructive Surgery (ESOPRS) recommendations for oculoplastic surgeons during the COVID-19 pandemic: a hallenge for the future.

In March 2020, at the outset of the current pandemic, ESOPRS issued detailed advice on the appropriate procedures that practicing oculoplastic surgeons should consider to limit the transmission of COVID-19, with this information updated in April 2020. This paper highlights the threat to training opportunities for future generations of oculoplastic surgeons, adjustments in healthcare delivery, modifications of scientific activity, and the possible role of telemedicine in oculoplastics.

Telemedicine comes of age during coronavirus disease 2019 (COVID-19): An international survey of oculoplastic surgeons.

PURPOSE: The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing healthcare crisis that continues its worldwide spread. Ophthalmologists are at high risk of acquiring and transmitting the virus. Telemedicine platforms have evolved and may play an important role in attenuating this risk. For patients, these platforms provide the possibility of clinic consultation without the concerns of a clinic visit. We aimed to assess the utilization of telemedicine by oculoplastics specialists worldwide during the COVID-19 pandemic. METHODS: A 13-item survey was distributed internationally to practicing oculoplastic surgeons. Collected data included demographics, clinical practice variables and perceptions regarding telemedicine. Significance of associations and single survey items was evaluated by Chi-squared and z-score of proportions tests, respectively. RESULTS: The questionnaire was completed by 70 oculoplastic surgeons (54.3% male, mean age 47.3 years, median experience 10 years) from eight countries, practicing in various clinical settings (50.0% hospitals, 45.7% private clinics, 4.3% community clinics). Most respondents reported telemedicine to be an effective tool for oculoplastic consultations (67.1%, p = 0.004), while only 12.8% (p < 0.00001) had incorporated this modality into clinical practice prior to the pandemic. Even though a vast majority (98.6%) of participants had limited outpatient activity, most (55.7%) felt unprotected from the virus. Telemedicine had been incorporated by 70.5% (p = 0.001) of respondents during the COVID-19 pandemic, whereas most (57.1%) predicted continued use of the modality. CONCLUSION: Telemedicine can be effectively and rapidly incorporated into the clinical practice of oculoplastic surgeons during the COVID-19 pandemic. Further research into the most effective utilization of these platforms appears warranted.

Oculoplastic surgery practice during the COVID-19 novel coronavirus pandemic: experience sharing from Hong Kong.

At present, all parts of the world are hit hard by COVID-19. The first confirmed case of COVID-19 in the territory of Hong Kong was announced on January 23, 2020. Since then, oculoplastic surgeons in Hong Kong have been taking every measure to protect all healthcare workers and patients from contracting the disease. This paper aims to share the experiences of and measures taken by local oculoplastic surgeons in combating COVID-19. Three main aspects are discussed, namely clinical, administrative, and training and educational. We hope our experiences would provide reference to fellow oculoplastic colleagues in other parts of the world in fighting this COVID-19 pandemic.