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      Change in Ophthalmology Practice during COVID-19 Pandemic: Egyptian Perspective

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose: To assess the impact of the COVID-19 pandemic on ophthalmology practice in the Cairo metropolitan area. Methods: This is a cross-sectional observational analytic study among ophthalmologists practicing in different hospitals in the Cairo metropolitan area. The data were collected through a self-administered questionnaire covering general measures taken during practice. Results: The questionnaire was sent to 250 ophthalmologists, with an 82% response rate. Most of the participants were concerned about the economic impact of the pandemic, as there is a 60–80% reduction in the flow of patients with a consequent 80–100% reduction in surgical cases. Most of the participants have access to personal protective equipment, and the safety protocols are followed, especially by the older ophthalmologists. Thus, the surgeons are willing to perform elective surgeries, adhering to strict safety protocols (70.8, 42.6, and 18.8% of the refractive surgeons, corneal surgeons, and retinal surgeons, respectively; p = 0.00). Furthermore, 63.9% of the participants, especially the young ophthalmologists, are willing to see COVID-19 patients and operate on them if needed. Conclusions: The COVID-19 pandemic could go on for months or even years with a significant impact on ophthalmology practice. Trying to keep a balance between safety and economic burden, the majority of ophthalmologists are willing to see elective patients and urgently operate on a COVID-19 patient, under adherence to the safety protocols.

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          Most cited references4

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          Novel Coronavirus disease 2019 (COVID-19): The importance of recognising possible early ocular manifestation and using protective eyewear

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            Survey of ophthalmology practitioners in A&E on current COVID-19 guidance at three Major UK Eye Hospitals

            To the Editor: The 2019 novel coronavirus disease COVID-19, originally responsible for a cluster of pneumonia cases in Wuhan, China, has now become a global pandemic according to the World Health Organisation (WHO) with 132,758 cases and 4955 deaths globally as of 13 March 2020 [1]. Common symptoms of COVID-19 include fever, cough, dyspnoea and malaise. The disease is thought to spread via respiratory droplets among persons in close contact and possibly from contaminated surfaces [2]. Reports have also suggested that the virus can cause conjunctivitis and may be transmitted by aerosol contact with conjunctiva [3]. Ophthalmology practitioners may be susceptible to infection due to close patient proximity during slit lamp examination and the potential contamination of instruments [4]. We conducted a self-administered anonymous survey (Google Forms) disseminated by email of ophthalmology doctors, nurses, optometrists and healthcare assistants employed at Moorfields Eye Hospital, Western Eye Hospital and Manchester Royal Eye Hospital from 10 March 2020 to 12 March 2020 to assess perception of COVID-19 exposure risk, understanding and confidence in current Public Health England (PHE) guidelines for identifying possible COVID-19 cases, knowledge of Personal Protective Equipment (PPE) recommendations and training in its usage when managing such cases. There was also a free text option for additional comments. A total of 100 practitioners completed the survey comprising doctors (80%), optometrists (11%), nurses (8%) and healthcare assistants (1%). Eighty percent of respondents felt at high risk of COVID-19 transmission at work, 12% did not and 8% were not sure. Most respondents felt published guidelines were not sufficient for identifying patients with or at risk of COVID-19 (Fig. 1). Respondents generally had poor confidence in guidelines which did not require ophthalmology practitioners in A&E to routinely wear PPE, and the majority had not had training in its use. There was a lack of understanding of recommended PPE for close patient contact with possible cases (Fig. 2). Several respondents raised concerns about the very close proximity of 20–30 cm to patients during slit lamp examinations and the need for effective triage for non-urgent eye problems. One respondent raised concerns about the lack of guidance for managing patients presenting to standalone eye units with suspected COVID-19 requiring emergency ophthalmic surgery. Fig. 1 Demographics of survey respondents, perceived risk of COVID-19 transmission and confidence in PHE COVID-19 guidelines. Survey of ophthalmology practitioners working in A&E. Fig. 2 Knowledge and confidence of using PPE among ophthalmology practitioners in A&E. Our survey demonstrates a lack of confidence in and understanding of COVID-19 PHE guidance amongst ophthalmic practitioners, together with significant anxiety regarding exposure risk in the ophthalmic setting. Reflecting this, standalone eye hospitals have started to introduce their own protective equipment measures outside of PHE and RCOphth guidance such as acetate slit lamp screens and FFP3 respirators for all clinical staff in A&E. This lack of coordination amongst units risks generating further confusion for staff and patients. Given the rapidly evolving situation, effective dissemination of and adherence to regularly updated PHE guidelines is prudent to instil confidence amongst practitioners and to ensure a co-ordinated evidence-based response across the ophthalmic workforce. Revisiting strategies applied within the ophthalmic setting during previous novel coronavirus outbreaks such as SARS-CoV may well reduce transmission and save lives [5].
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              Important coronavirus updates for ophthalmologists.

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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2021
                February 2021
                30 July 2020
                : 244
                : 1
                : 76-82
                Affiliations
                Department of Ophthalmology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
                Author notes
                *Hebatalla Samir Makled, Department of Ophthalmology, Kasr Al Ainy Hospital, Cairo University, Cairo 11562 (Egypt), dr.h.makled@hotmail.com
                Author information
                https://orcid.org/0000-0002-9767-8912
                Article
                510548 Ophthalmologica 2021;244:76–82
                10.1159/000510548
                32731247
                b94e56bc-6360-405c-a92d-a4746bdd6667
                © 2020 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 17 May 2020
                : 17 July 2020
                Page count
                Figures: 2, Tables: 3, Pages: 7
                Categories
                Research Article

                Vision sciences,Ophthalmology & Optometry,Pathology
                Cairo metropolitan area,Personal protective equipment,Ophthalmology practice,COVID-19

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