Ophthalmic Outpatient and Inpatient Care Under Pandemic Conditions: Hygiene, Triage and New Challenges

Abstract

Background The progression of the COVID-19 pandemic has caused significant changes in the environment for outpatient and inpatient care in ophthalmology, with limitations on access to medical care but also new observations and challenges. We now describe major developments in recent months and provide an outlook on the expected consequences.

Methods PubMed literature search, clinical survey.

Results To date, the course of the COVID-19 pandemic has been characterised by several new but overall rare ocular manifestations, the ophthalmological shared management of COVID-19 patients on intensive care units, and a significant decrease in case numbers, associated with an increase in case severity and relative proportion of emergencies, as a result of delayed presentation of patients and reduced treatment adherence. With the introduction of hygiene measures and infection control procedures, ophthalmic patient care was maintained – including emergencies and urgent treatments. Due to the extensive postponement of elective surgeries, scarce therapeutic and health care professional resources, and the prioritisation of critically ill patients from other specialties, there is a reasonable likelihood that urgent treatments will be delayed as infection rates rise.

Conclusion Outpatient and inpatient care in ophthalmology during the COVID-19 pandemic is primarily accompanied by additional organisational or medical challenges and a decline in case volume. Although to date emergency and urgent ophthalmic treatments have been maintained, long-term persistence of pandemic conditions will require additional strategies to provide continuation of ophthalmic care at the required level.

Key words

COVID-19 pandemic - ocular manifestation COVID-19 - hygiene measures - ophthalmic emergencies - triage

Publication History

Received: 15 February 2021

Accepted: 19 April 2021

Article published online:
21 May 2021

• References/Literatur

• 1 Søreide K, Hallet J, Matthews JB. et al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 2020; 107: 1250-1261 DOI: 10.1002/bjs.11670.
• 2 COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020; 107: 1440-1449 DOI: 10.1002/bjs.11746.
• 3 Hattenbach LO, Reinhard T, Walter P. et al. Crisis management strategies of hospitals during the pandemic. Ophthalmologe 2020; 117: 652-658 DOI: 10.1007/s00347-020-01162-x.
• 4 Poeran J, Zhong H, Wilson L. et al. Cancellation of elective surgery and intensive care unit capacity in New York state: a retrospective cohort analysis. Anesth Analg 2020; 131: 1337-1341 DOI: 10.1213/ANE.0000000000005083.
• 5 Tonna JE, Hanson HA, Cohan JN. et al. Balancing revenue generation with capacity generation: Case distribution, financial impact and hospital capacity changes from cancelling or resuming elective surgeries in the US during COVID-19. medRxiv 2020; DOI: 10.1101/2020.04.29.20066506.
• 6 Hattenbach LO, Heinz P, Feltgen N. et al. [Impacts of the SARS-CoV-2 pandemic on ophthalmic care in Germany]. Ophthalmologe 2020; 117: 892-904 DOI: 10.1007/s00347-020-01220-4.
• 7 Pellegrini M, Roda M, Lupardi E. et al. The impact of COVID-19 pandemic on ophthalmological emergency department visits. Acta Ophthalmol 2020; 98: e1058-e1059 DOI: 10.1111/aos.14489.
• 8 Viola F, Milella P, Giuffrida FP. et al. The impact of coronavirus disease (COVID-19) pandemic on intravitreal injections treatment for macular diseases: report from a referral hospital in Milan. Retina 2021; 41: 701-705 DOI: 10.1097/IAE.0000000000002941.
• 9 Moon JY, Miller JB, Katz R. et al. The Impact of the COVID-19 Pandemic on Ophthalmic Care at an Eye-Specific Emergency Department in an Outbreak Hotspot. Clin Ophthalmol 2020; 14: 4155-4163
• 10 Poyser A, Deol SS, Osman L. et al. Impact of COVID-19 pandemic and lockdown on eye emergencies. Eur J Ophthalmol 2020; DOI: 10.1177/1120672120974944.
• 11 Vestergaard LS, Nielsen J, Richter L. et al. Excess all-cause mortality during the COVID-19 pandemic in Europe – preliminary pooled estimates from the EuroMOMO network, March to April 2020. Euro Surveill 2020; 25: 2001214 DOI: 10.2807/1560-7917.ES.2020.25.26.2001214.
• 12 Nørgaard SK, Vestergaard LS, Nielsen J. et al. Real-time monitoring shows substantial excess all-cause mortality during second wave of COVID-19 in Europe, October to December 2020. Euro Surveill 2021; 26: 2002023 DOI: 10.2807/1560-7917.ES.2021.26.1.2002023.
• 13 Argenziano M, Fischkoff K, Smith CR. Surgery Scheduling in a Crisis. N Engl J Med 2020; 382: e87
• 14 Diaz A, Sarac BA, Schoenbrunner AR. et al. Elective Surgery in the Time of COVID-19. Am J Surg 2020; 219: 900-902 DOI: 10.1016/j.amjsurg.2020.04.014.
• 15 Ralli M, Minni A, Candelori F. et al. Effects of COVID-19 Pandemic on Otolaryngology Surgery in Italy: The Experience of Our University Hospital. Otolaryngol Head Neck Surg 2020; 163: 86-88 DOI: 10.1177/0194599820928970.
• 16 Taha MA, Hall CA, Rathbone RF. et al. Rhinologic Procedures in the Era of COVID-19: Health-care Provider Protection Protocol. Am J Rhinol Allergy 2020; 34: 451-455
• 17 Gupta A, Arora V, Nair D. et al. Status and Strategies for the Management of Head and Neck Cancer During COVID-19 Pandemic: Indian Scenario. Head Neck 2020; 42: 1460-1465
• 18 Boettler T, Newsome PN, Mondelli MU. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep 2020; 2: 100113
• 19 Olivia Li JP, Shantha J, Wong TY. Preparedness among Ophthalmologists: During and Beyond the COVID-19 Pandemic. Ophthalmology 2020; 127: 569-572
• 20 Karampelias V, Spanidis Y, Kehagias I. Surgical practice and operative surgical strategies during the COVID-19 pandemic: A commentary. Ann Med Surg (Lond) 2020; 55: 47-48
• 21 Skalet AH, Allen RC, Shields CL. et al. Considerations for the Management and Triage of Ocular Oncology Cases during the COVID-19 Pandemic. Ocul Oncol Pathol 2020; 6: 1-4
• 22 Rokohl AC, Loreck N, Wawer Matos PA. et al. Die Rolle der Augenheilkunde in der COVID-19-Pandemie. Ophthalmologe 2020; 117: 642-647 DOI: 10.1007/s00347-020-01148-9.
• 23 Arons MM, Hatfield KM, Reddy SC. Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. N Engl J Med 2020; 382: 2081-2090
• 24 Glauser W. Proposed protocol to keep COVID-19 out of hospitals. CMAJ 2020; 192: E264-E265
• 25 Seah IYJ, Anderson DE, Kang AEZ. et al. Assessing Viral Shedding and Infectivity of Tears in Coronavirus Disease 2019 (COVID-19) Patients. Ophthalmology 2020; 127: 977-979 DOI: 10.1016/j.ophtha.2020.03.026.
• 26 Aggarwal K, Agarwal A, Jaiswal N. et al. Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. PLoS One 2020; 15: e0241661 DOI: 10.1371/journal.pone.0241661.
• 27 Rokohl AC, Grajewski RS, Wawer Matos PA. et al. No secret hiding place? Absence of SARS-CoV-2 on the ocular surface of 1145 hospitalized patients in a pandemic area. Graefes Arch Clin Exp Ophthalmol 2021; 29: 1-4 DOI: 10.1007/s00417-021-05086-3.
• 28 Rokohl AC, Loreck N, Wawer Matos PA. et al. More than loss of taste and smell: burning watering eyes in coronavirus disease 2019. Clin Microbiol Infect 2020; 26: 1560.e5-1560.e8 DOI: 10.1016/j.cmi.2020.08.018.
• 29 Lange C, Wolf J, Auw-Haedrich C. et al. Expression of the COVID-19 receptor ACE2 in the human conjunctiva. J Med Virol 2020; 92: 2081-2086 DOI: 10.1002/jmv.25981.
• 30 Lim LW, Yip LW, Tay HW. et al. Sustainable practice of ophthalmology during COVID-19: challenges and solutions. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1427-1436
• 31 Van Gerven L, Hellings PW, Cox T. et al. Personal Protection and Delivery of Rhinologic and Endoscopic Skull Base Procedures During the COVID-19 Outbreak. Rhinology 2020; 58: 289-294 DOI: 10.4193/Rhin20.119.
• 32 Heiduschka P, Lauermann JL, Bosche FD. et al. Ein Schutz gegen die Tröpfcheninfektion an der Spaltlampe. Sicherheit für die Augenärzte UND die Patienten. Ophthalmologe 2020; 117: 296-297
• 33 Lazzerini M, Barbi E, Apicella A. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health 2020; 4: e10-e11
• 34 Yıldırım M, Geçer E, Akgül Ö. et al. The Impacts of Vulnerability, Perceived Risk, and Fear on Preventive Behaviours Against COVID-19. Psychol Health Med 2020; 3: 1-9
• 35 Korobelnik JF, Loewenstein A, Eldem B. et al. Guidance for anti-VEGF Intravitreal Injections During the COVID-19 Pandemic. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1149-1156
• 36 Borrelli E, Grosso D, Vella G. et al. Short-term outcomes of patients with neovascular exudative AMD: the effect of COVID-19 pandemic. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2621-2628 DOI: 10.1007/s00417-020-04955-7.
• 37 Wasser LM, Weill Y, Brosh K. et al. The Impact of COVID-19 on Intravitreal Injection Compliance. SN Compr Clin Med 2020; DOI: 10.1007/s42399-020-00614-4.
• 38 Borrelli E, Grosso D, Vella G. et al. Impact of COVID-19 on outpatient visits and intravitreal treatments in a referral retina unit: letʼs be ready for a plausible “rebound effect”. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2655-2660
• 39 Bayram N, Gundogan M, Ozsaygılı C. et al. The Impacts of Face Mask Use on Standard Automated Perimetry Results in Glaucoma Patients. J Glaucoma 2021; 30: 287-292 DOI: 10.1097/IJG.0000000000001786.
• 40 Thuret G, Courrier E, Poinard S. et al. One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe. Br J Ophthalmol 2020; DOI: 10.1136/bjophthalmol-2020-317938.
• 41 Bhalla M, Jolly R, Jain S. COVID-19: The Role of the Ophthalmologist in ICU. Sem Ophthalmol 2020; 35: 313-315 DOI: 10.1080/08820538.2020.1843687.
• 42 Borgmann H, Struck JP, Mattigk A. et al. Increased Severe Adverse Outcomes and Decreased Emergency Room Visits for Pyelonephritis: First Report of Collateral Damage during COVID-19 Pandemic in Urology. Urol Int 2021; 105: 199-205 DOI: 10.1159/000513458.
• 43 Metzler B, Siostrzonek P, Binder RK. et al. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J 2020; 41: 1852-1853 DOI: 10.1093/eurheartj/ehaa314.
• 44 Sud A, Jones ME, Broggio J. et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol 2020; 31: 1065-1074 DOI: 10.1016/j.annonc.2020.05.009.
• 45 Emanuel EJ, Persad G, Upshur R. et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med 2020; 382: 2049-2055
• 46 Prager KM, Dagi Glass LR, Wang M. et al. Ophthalmology and Ethics in the COVID-19 Era. Am J Ophthalmol 2021; 224: 158-162 DOI: 10.1016/j.ajo.2020.11.008.
• 47 Inomata T, Kitazawa K, Kuno T. et al. Clinical and Prodromal Ocular Symptoms in Coronavirus Disease: A Systematic Review and Meta-Analysis. Invest Ophthalmol Vis Sci 2020; 61: 29 DOI: 10.1167/iovs.61.10.29.
• 48 Gouveia PADC, Cipriano IC, de Melo MAZ. et al. Exuberant bullous vasculitis associated with SARS-CoV-2 infection. IDCases 2021; 23: e01047 DOI: 10.1016/j.idcr.2021.e01047.
• 49 Galanis N, Stavraka C, Agathangelidis F. et al. Coagulopathy in COVID-19 infection: a case of acute upper limb ischemia. J Surg Case Rep 2020; 2020: rjaa204 DOI: 10.1093/jscr/rjaa204.
• 50 Ramachandran R, Vasudevan Pillai A, Raja S. et al. Axillary artery thrombosis resulting in upper limb amputation as a COVID-19 sequela. BMJ Case Rep 2021; 14: e240981 DOI: 10.1136/bcr-2020-240981.
• 51 Page EM, Ariëns RAS. Mechanisms of thrombosis and cardiovascular complications in COVID-19. Thromb Res 2021; 200: 1-8 DOI: 10.1016/j.thromres.2021.01.005.
• 52 Salabei JK, Fishman TJ, Asnake ZT. et al. COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation. Heart Lung 2020; 50: 357-360 DOI: 10.1016/j.hrtlng.2021.01.011.
• 53 Sheth JU, Narayanan R, Goyal J. et al. Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol 2020; 68: 2291-2293 DOI: 10.4103/ijo.IJO_2380_20.
• 54 Monferrer-Adsuara C, Castro-Navarro V, González-Girón N. et al. A case of bilateral unusual retinal hemorrhages in a COVID-19 patient. Eur J Ophthalmol 2020; DOI: 10.1177/1120672120984381.
• 55 Gaba WH, Ahmed D, Al Nuaimi RK. et al. Bilateral Central Retinal Vein Occlusion in a 40-Year-Old Man with Severe Coronavirus Disease 2019 (COVID-19) Pneumonia. Am J Case Rep 2020; 21: e927691 DOI: 10.12659/AJCR.927691.