Clinical practice and surgery in ophthalmology: how to restart after the pandemic

Comparison of opinions by internationally renowned experts, summary of "Take-home messages" and links to the entire event in streaming. 

Frenetic days are being experienced around the world, marked by the resumption of all activities after the COVID-19 pandemic lock-down. The end of the lock-down requires caution and gradualness and presents particularly complex problems in public and private healthcare settings.
Of great interest, therefore, was the debate that featured international opinion leaders who, in the SIFI Global webinar on 9 May 2020, discussed the hottest issues that need to be addressed to manage the restart of clinical and surgical practice in ophthalmology.

The panel speakers are:
Asia-Pacific:

1. Chung Tae-Young - Seoul, South Korea
2. Victor Caparas - Manila, Philippines
3. Jodbhir Mehta - Singapore
4. D. Ramamurthy - Coimbatore, India

Europe:

1. Emilio Pedrotti - Verona, Italy
2. Gerd Auffarth - Heidelberg, Germany
3. Ramon Ruiz Mesa - Andalucia, Spain

The webinar, which was attended by 717 users from 36 countries and an in-depth Q&A session, is now available for streaming at this link.

https://attendee.gotowebinar.com/recording/5990948995468603147

We also provide an English language summary of the "Take Home Messages, which the experts shared and which is associated with their invitation to listen to the seminar in its entirety so that you can receive feedback and suggestions that may be useful to you, your staff and your patients.

"Be safe and remain adaptable to the changes ahead. We are now in a 'new-normal' and things will continue to evolve for sure in the weeks, months and years ahead."

The Webinar Panellists

Take Home Messages - SIFI Global Webinar

"How Do We Restart Our Clinical & Surgical Practices".

Below is a summary of the salient "Take Home Messages" from May 9^th2020 Global Webinar. Please review and share these key insights provided by the 7 Panellists from the webinar.

1. Patient monitoring in the OR / OT and also In-Patient / Day Surgery and / or OPD.
   1. Panellists shared insights about COVID-19 testing of patients before they were brought in for surgical procedures and also if positive patients were brought in, careful PPE and protocols were used to handle the patient in the clinics, OR and in-patient environments. South Korea for example tested all patients before they were admitted into a hospital and surgical setting, to make sure no positive cases were brought into the hospital.
   2. Several markets would provide PCR and antibody testing to patients before doing surgical procedures on them.
   3. Staff were broken down into teams that did not cross over and work with other colleagues in the clinic. Effective and proper PPE were used and staff exposure was kept to a minimum.
   4. Staff in a clinical and surgical setting were tested once every 7-14 days to determine if they were positive or not.
2. PPE Protection for Doctors & Clinic / OR Staff.
   1. All panellists used N-95 masks for themselves in their clinics when seeing patients.
   2. Some markets also provided N-95 masks to their staff and OR teams, otherwise standard surgical marks were used by all clinical and OR staff.
   3. Several of the panellists recommended using eye shields and eye wear in addition to wearing surgical / face masks.
   4. Some panellists talked about having their own individual respirators if they were operating on a COVID-19 positive cases. Wearing face masks and eye shield protection as also highly recommended (goggles and face shields).
3. Patient Measures / Better Protection:
   1. Social distancing in the clinics was an important step for staff, patients and well-being of the team overall.
   2. Smaller waiting room crowds was a key step to be taken as clinics started to reopen up.
   3. Making sure that patients also wear masks when in the clinic and if and when possible in the OR.
   4. Special protection and care needed to be taken when dealing with GA patients - especially high risk patients - protection of the OR staff and doctors is of paramount concern.
4. Population Testing Before Coming to Clinics / Surgery:
   1. Where possible, patients should seek test for COVID-19 before coming to clinics.
   2. Started triage and temperature / history protocols will be followed, but if possible, getting tested in advance before coming to a clinic or scheduled surgical / OT visit would be a good thing to have.
   3. General testing and large-scale population testing should be done where positive, as patients that might test negative, but are still positive for the virus. Better testing regimes need to be followed.
5. Regular Testing / Monitoring of Doctors, Nurses, Clinic Staff & HCWs:
   1. Weekly / Fortnightly testing should be provided to doctors and staff and that should be shared with patients as well - building confidence with the patients that they are dealing with a safe environment.
   2. Working in smaller / adaptable teams to prevent cross-over / contamination where and when possible.
   3. Anti-body testing should be provided to doctors and staff as well. This becomes a positioning effort to patients that they are dealing with a clinic / hospital that cares for their doctors and staff and is a safe place to come for ocular care, treatment and surgeries.
6. Ocular Transmission:
   1. Very easy to transmit COVID-19 through tears and ocular surfaces.
   2. The panellists all agreed that it is safe to perform phaco on patients and corneal procedures like SMILE, LASIK etc., as long a good PPE is used and good sterile procedures are followed by doctors, staff and patients.
   3. Several panellists talked about making sure that patients are COVID-19 negative before performing corneal graft surgery.
   4. Using slit-lamp shields is vitally important and being certain to practice good hygiene - wearing of gloves when touching patients around the face and eye.
   5. Some talked about performing bilateral cataract surgery to reduce patients' visits to the clinic. Might be something to consider in various clinical and surgical settings.
7. Practice Changes: Tele-Consulting / Video-Consulting and various issues:
   1. Reimbursement issues.
   2. Legal/malpractice issues
   3. Data safety issues
   4. EMR that work with data collection for tele-medicine and phone consultation (recording of calls and patient interactions etc.).
   5. Changes will invariably come, and all panellists felt that tele-medicine would play a big role in efforts to provide social distancing and less F2F interaction in person with clinic and doctor visits.
8. Private vs. Public Clinics / Practices and their survival
   1. Varying thoughts on this.
   2. Some panellists stated that large hospitals and public hospitals will survive and weather the storm.
   3. Some felt that smaller clinics - 1 or 2 doctor clinics will struggle over the next 12 months but come out stronger at the other end.
   4. Better legislation and ophthalmic society support needed to happen to standardise protocols of patient interaction in clinics, workflow in the clinic/hospital and OR and greater transparency for doctors, HCWs and patients.
   5. Public clinics should offer patient testing if at all possible.

Dr. Carmelo Chines
Direttore responsabile