EyeWorld India June 2021 Issue

FEATURE 16 EWAP JUNE 2021 social distancing, in re-opened clinic areas. Doctor and clinic rosters and templates were all moderated to allow better social distancing. “Operating theater operations did not experience as drastic a change as PPE equivalents were daily practised. Contingency plans e.g. N95 for managing active COVID patients were drawn, but fortunately, not required. Full N95 PPE was required for all general anesthesia cases.” Q2: Never looking back Lee Mun Wai, MD LEC Eye Centre Ipoh, Malaysia “We have changed the way we schedule our patients and how we roster our doctors’ activities (i.e., clinics, minor a nd major procedure lists, etc.), and this has made efficient use of our resources. This is something that we are likely to continue doing even in the post- COVID era.” Hiroko Bissen-Miyajima, MD Tokyo Dental College Suidobashi Hospital Tokyo, Japan “Before the pandemic, we had already performed the surgery assuming that the patient has some sort of contagious disease such as hepatitis. We use disposable instruments and materials as much as possible, and change the cover of the knobs of surgical microscopes and diagnostic machines. Thus, we did not change our procedures and techniques.” Sheetal Brar, MD Nethradhama Superspeciality Eye Hospital Bangalore, India “To reduce the risk of viral transmission through fomites and surfaces, we have stopped issuing hard copies of patients’ records to the patients, which we used to do before. Instead, we have developed an application which can be downloaded by the patients on their mobile, through which they can access their complete record including plan of care, glasses, and medication prescriptions, as well as laboratory reports. Patients can also schedule their next appointment through this app and contact the hospital whenever required for any eye-related problems. This is something we plan to continue even after the pandemic is over. Since the pandemic is still continuing with a second wave hitting India even harder, all safety protocols will be continued to be strictly followed, until the pandemic comes to a complete halt.” Do Hyung Lee, MD, and In Kwon Chung, MD Ilsan Paik Hospital, Inje University Koyang [Goyang], South Korea “As COVID-19 is prolonged, it is impossible to reduce numbers of outpatient and elective surgery. The ophthalmologists should be careful not to infect each other by respiratory droplets and eye secretions, especially when they practice treatment at a close distance from the patient. “Following instructions are required: 1. Slit-lamp breath shields should be installed in front of the slit lamp microscope to avoid contact with any secretions between the patient and the doctor. 2. As alcohol or bleach-based disinfectants commonly used when disinfecting ophthalmic devices due to its effectiveness in sterilizing SARS-CoV-2, such method is recommended to prevent the spread of other viral infections (e.g., 70% alcohol). Special care must be taken in disinfecting devices that encountered the patient’s body part, such as an applanation tonometer. 3. During surgery, it is recommended that patients also need to wear masks, and preoperative testing is necessary in consideration of the possibility of spreading aerosolized virus by asymptomatic patients. 4. In the case of corneal transplantation, when the donor dies, it is unknown whether the patient is asymptomatic or carrier of the coronavirus. A doctor who practices enucleation surgery may be in danger of infection, and it is possible that the virus survives in the eyes and secretions for several hours after death so that a recipient can be infected by transplantation. Therefore, corneal transplantation should be performed after sufficient consent. “Disinfection with povidone iodine is required in the operating room as it is effective in killing widespread viruses including SARS-CoV-1 and MERS-CoV. Therefore, it is expected to be effective in viruses that caused COVID-19 as well.” Edmund Wong, MD Singapore National Eye Centre Singapore “More spaced outpatient numbers, active eye on social distancing within clinics would be a change from previous, where due to increased spot demand, occasional over- crowding may have been previously tolerated. “Other workflows mostly reverted to original processes.” EWAP Editors’ note: The doctors declared no financial or other conflicting interests relevant to their responses.