EyeWorld India June 2021 Issue

FEATURE EWAP JUNE 2021 15 To combat the effects of the pandemic, we have adopted several measures in order to ensure safe and effective delivery of eye care services. Screening of all patients for temperature and symptoms, along with a questionnaire regarding a relevant travel and health history, is mandatory for all patients presenting for consultation. All staff personnel and ophthalmologists, who are likely to come in direct contact with patients, are provided with protective personal equipment (PPE) that include an N95 mask, gown, gloves, and eye protection (a face shield or goggles). Slit-lamp barriers have been installed and daily disinfection of surfaces and waiting areas is being performed. Staff are instructed to maintain social distancing (1 meter or more) at all times inside the premises of the hospital, which is also being followed for the patients in the waiting area. Elective patients for cataract surgery and other procedures need to have a mandatory RT-PCR report for COVID-19 as negative to be eligible for surgery. For emergency cases, where getting a report is not possible, strict safety protocols such as N-95 Mask for patient, full PPE for the operative surgeon and assisting staff, and immediate sterilization of the OR and instruments is followed. Tele- consultations are encouraged for non-emergency conditions and most of our academic lectures and interviews have become virtual.” Do Hyung Lee, MD, and In Kwon Chung, MD Ilsan Paik Hospital, Inje University Koyang [Goyang], South Korea “Lack of information about COVID-19 In the early stages led ophthalmology’s inexperienced action against the disease by solely emphasizing the risk of infection by droplet rather than by contact or aerosol. However, the atmosphere changed when the infection and death of an eye doctor were reported in Wuhan due to COVID-19. We discovered that COVID-19 can cause minor follicular conjunctivitis, which is difficult to distinguish from other types of viral conjunctivitis. Viral RNA can be detected in tears of confirmed COVID-19 patients with conjunctivitis symptoms and infection by aerosol through conjunctiva is possible. As a result, the American Academy of Ophthalmology (AAO) and Korean Ophthalmology Society (KOS) provided ophthalmologists the following guidelines for COVID-19 prevention to each hospital : 1. Maintain appropriate distance among patients in the waiting area. 2. Patients with fever or respiratory disease should wear a mask and wait in a separate space as much as possible. If infection is suspected, immediately report via verbal or telephone to the local public health center or Korea Disease Control and Prevention Agency. 3. Confirmation of visitor’s overseas travel history and contact with infected patients: required thorough medical and candidate qualifications examination. 4. Before and after treatment, doctors should wear masks, observe personal hygiene rules, install a slit lamp breath shield, and thoroughly disinfect instruments and equipment. 5. When treating a COVID-19 suspected patient, special attention is required to protect the eyes, nose, and mouth, and wear personal protective equipment including an N-95 mask, goggles, or safety glasses.” Edmund Wong, MD Singapore National Eye Centre Singapore “COVID-19 has changed many things in the healthcare landscape. For ophthalmology practice at the Singapore National Eye Centre (SNEC), the pandemic required changes in the entire patient care journey and even staffing manpower levels due to external deployments. “In the outpatient setting, patient numbers, processes to triage patient visits, outpatient clinic reorganisations, clinic level operations, pharmacy and outpatient billing. Overall patient numbers allowed to be seen in the clinics needed to be rapidly adjusted following Government directions on overall population movements within the country. During Circuit Breaker months of April-May 2020, we trimmed outpatient numbers down to 20-30% of normal by Doctors vetting electronic records to decide which patients could be safely deferred. This of course required huge logistical backend patient re-scheduling. “All medical, nursing, and allied health staff were also split into 2 teams for the various clinical areas including our branches at the peak of the pandemic. With many staff deployed externally at assist at national-level disease containment efforts, clinic areas were also trimmed in keeping with patient numbers. Patients needed to pre-register at a centralised triage station at SNEC entrance logging contact details, with health and travel declarations. Isolation areas were prepared for suspect and positive cases where staff would be in full PPE. “Optimization of patient testing/imaging, condensed clinical review, streamlined outpatient treatments e.g. IVT injections were all carried out. Finally, home delivery of pharmacy items, and encouraging online bill payments were all done to minimize dwell time in the Centre. “After circuit break, a reverse process to ramp up patient numbers safely, with proper