26^th September, 2020, 4-5pm

Participants: Dr KK Aggarwal, President CMAAO; Dr RV Asokan, Hony Secretary General IMA; Dr Ramesh K Datta, Hony Finance Secretary IMA; Dr Jayakrishnan Alapet; Dr VK Goel, Dr RS Hazuria; Dr S Sharma

Faculty: Dr AK Grover, Chairman, Dept. of Ophthalmology, Sir Ganga Ram Hospital, Chairman, Vision Eye Centres, Siri Fort Road and West Patel Nagar, New Delhi

Key points from the discussion

• Left eye conjunctivitis is most common in COVID-19.
• VP Mike Pence, USA, was seen with left eye involvement ?COVID-19
• Transmission can occur through the ocular surface or aerosol contact with the conjunctiva. Hence, eye protection is an integral component of the protective measures to be taken by a person taking care of a person with COVID.
• Conjunctivitis may be the first presenting symptom. Conjunctival congestion has also been observed in confirmed cases of infection.
• There are anecdotal reports of vascular occlusion and immune phenomenon occurring in the orbit and other structures of the eye. But these have not yet been documented significantly.
• The risk of transmission in ophthalmology is very real because of the proximity in examination and treatment procedures. The concentration on the surface of the eye may not be so high and the ACE2 receptors here may not be as dense as in the lungs, so there should not be paranoia. Follow all screening protocols, have a good system of triage and follow hygiene measures to prevent risk of transmission. Eye protection should be used by clinicians to avoid transmission through the surface.
• Studies have shown that the virus is present in tears of patients (moderate to severe cases); may also be present in asymptomatic persons.
• A landmark study from India has demonstrated the virus in tears of 24% of patients with lab proven moderate to severe COVID-19 by conjunctival swab (RT PCR). This indicates a high possibility of transmission of the virus through tears in these patients.
• COVID-19 has had a severe impact on day-to-day work.
• COVID-19 and the lockdown that followed have affected patient care. A study from Aravind Eye hospital, Madurai, done from March 25-May 3 showed that OPD visits and retinal laser procedures have decreased by 96.5%; sight saving intravitreal injections decreased by 98% and cataract surgeries decreased by 99.7%.
• Very few corneal grafts were being done during this period, resulting in vision loss. Patients with open globe injuries underwent evisceration as they presented late.
• Emergency procedures could not be done due to logistic reasons.
• Community eye care also suffered – no screening camps, no community surgery, eye donations decreased, peripheral vision centers in rural areas were not functioning.
• COVID-19 has greatly affected residency education (theoretical, clinical and surgical); specially designed webinars for PG training have now started.
• COVID-19 has had an impact on day-to-day eye care practices. Most eye care is provided by stand-alone hospitals and most work is elective. The work is now picking up but is still around 50-60%. There was huge impact on turnover; at one point it was close to zero percent. Survival plans had to be worked on. Getting back after lockdown requires lot of modifications.
• A RT PCR test report (of last 48 hours) is must for all longer procedures; test is also advised for shorter procedures like cataract, but there has been some resistance.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA