EyeWorld India June 2021 Issue

FEATURE EWAP JUNE 2021 7 to the pandemic by adding medical and social screening questions for known or suspected COVID-19 donors, increasing medical director consults, COVID-19 donor testing, and collaboration with other eye banks to ensure the best stewardship of available tissue. “If we have resources that others don’t, then we really need to move things around so others can be covered and we can come together as an entire community,” Mr. Hellier said. The current COVID-19 addendum has been streamlined to two questions: 1. In the last 28 days, was he/she diagnosed with COVID-19, or did he/she test positive for COVID-19? 2. In the last 28 days, did he/ she have close contact with a person who was diagnosed with or suspected to have COVID-19? Initially, rule-outs were high due to uncertainty. In May 2020, Eversight had started to understand COVID-19 better, and by June they “got their legs back under them”—having gained a better understanding of COVID-19 and appropriate screening practices. The question came down to whether and when to test for COVID-19. False results, Mr. Hellier said, were high in the beginning, and testing was costly. However, they gained a greater sense of security with more information. Their options were: test all surgical-intent donors; test only surgical-intent donors with additional COVID-19 concerns; or test no donors, relying on screening and medical director approval. Eversight decided to test all surgical-intent donors, using RT-PCR. In review, they found that they had pulled out 23 corneas that would have been released for transplant had they not had a positive postmortem COVID-19 test result. “To our mind, that was 23 more instances of potential spread of the infection that we were able to eliminate because of the testing,” Mr. Hellier said. “This was pretty compelling evidence to us to continue.” Without a universal policy, Eversight unilaterally decided to have a negative COVID-19 result on all surgical corneas they recovered. This was treated as an extra data point to determine tissue safety, rather than as a “be-all, end-all.” The data was compelling enough for them to validate the need to continue testing. Mr. Hellier qualified Eversight’s decision by saying “other choices are not wrong, but we felt this was the best approach for our standards.” Nevertheless, the decision to test all has been of great help toward reassuring patients, noted fellow speaker and moderator of the webinar, Donald Tan, MD, Singapore. “It’s an important decision for patients, because all my transplant patients this year are asking about the risk of donor transmission on COVID, and the fact that we can tell them that we’re only using tissue from eye banks that have done COVID testing on all their donors is very reassuring,” Dr. Tan said. Overcome Having adapted to the pandemic, Eversight sought to overcome its challenges, starting a series of Eversight Webinars to engage with surgeons and discuss topics of interest, establishing Eversight Virtual Wet Labs—the first truly 100% virtual wet labs—and promoting COVID-19 study and publication. Through these activities, Eversight believes they added value to the ophthalmology community during the pandemic. Mr. Hellier described a COVID study spearheaded by Eversight’s Onkar B. Sawant on the “Prevalence of SARS CoV-2 in human post-mortem ocular tissues.” 1 The study looked at 3 groups: Group 1 were asymptomatic COVID-19 positives; Group 2 were symptomatic COVID-19 negatives; and Group 3 were close contacts with a COVID-19 patient. Scleras had a higher positivity rate in Group 1 than Group 2 (17% vs. 12%). Conversely, corneas had a lower positivity rate in Group 1 than Group 2 (11% vs. 15%) In terms of the povidone Iodine rinse, the study found that in vitreous and conjunctiva, not only did it not matter, it actually had a higher prevalence of the disease. However, the rinse worked as expected for the anterior and posterior cornea. Mr. Hellier said that the take home from the study is that there is presense of RNA and spike proteins in the cornea, though we do not know if it is enough to transmit the disease. To the best of his knowledge, he said, while this study shows the possibility, we do not yet definitively know if the novel coronavirus can be transmitted through corneal transplants; further study is warranted. Meanwhile, the virtual wetlabs were designed to engage with surgeons during pandemic. “What better way to sharpen your skills or learn new ones than doing a wet lab,” Mr. Hellier said. “We found this way to take a phone adapter, mount it on the teaching microscope, and put your phone on there. We were able to do Zoom calls and instruct through Zoom breakout rooms.” “We did a couple and they turned out to be quite efficient and effective.” “These are just some ways in which eye banks were able to rise up and overcome these very unique times,” Mr. Hellier said. EWAP Reference 1. Sawant OB, et al. “Prevalence of SARS CoV-2 in human post-mortem ocular tissues.” Ocul Surf. 2021 Jan; 19: 322–329. Published online 2020 Nov 8. doi: 10.1016/j.jtos.2020.11.002. Editors’ note: Mr. Hellier declared no relevant financial interests.