Innovative solutions to improve protection from airborne pathogens during retinal imaging and examination

ABSTRACT

Purpose: To develop and evaluate custom solutions for ophthalmologists when performing retinal examination on patients with airborne communicable disease. Methods: Two solutions were developed for viewing and imaging patients with airborne communicable disease. The first solution was a custom indirect ophthalmoscope barrier shield consisting of a 3D printed bracket and laser cut shield. The shields were mounted using a rubber band fastening device to allow easy removal and cleaning. The bracket spaced the shield from the user to prevent fogging and heat generation. The central aperture allowed an unobstructed view of the retina. The second solution was a hand-held off the shelf portable fundus camera used with a Controlled Air-Purifying Respirator (CAPR) for providers examining patients in negative pressure rooms. Clinical viability was assessed with a survey completed by providers. Results: Providers completed the survey after use. No fogging obscured view of the retina. Ergonomically, the provider was able to maneuver and perform indirect ophthalmoscopy to the periphery. Spacing of the shield allowed use with a N95 and prevented heat buildup. The portable fundus camera was used with a CAPR successfully allowing the user to maintain full PPE while taking fundus photos of patients on airborne precautions. It was possible to use an N95 mask with the CAPR to prevent transmission of airborne particles from the user. Conclusions: There is a need for improved personal protective equipment due to the spread of COVID-19. Both solutions allowed ophthalmologists to maintain airborne precautions when examining patients. The first solution was compatible with a N95 mask and provided an additional face shield. This solution allowed viewing of the macula as well as far periphery. The second solution allowed use of a CAPR, making it suitable for providers who do not fit N95 masks. Photographs of the macula and mid-peripheral retina were possible with this option and dilation was not needed for examination. However, peripheral retinal viewing was more limited compared with the first option.