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LETTER TO THE EDITOR
Ahead of print publication  

Comment on “Proposed measures to be taken by ophthalmologists during the coronavirus disease 2019 pandemic: Experience from Chang Gung Memorial Hospital, Linkou, Taiwan”


1 Cornea and Refractive Surgery, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
2 Pediatric and Squint, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India

Date of Submission20-Sep-2020
Date of Acceptance13-Oct-2020
Date of Web Publication30-Apr-2021

Correspondence Address:
Kirandeep Kaur,
Pediatric and Squint Fellow, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry - 605 007
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjo.tjo_78_20



How to cite this URL:
Gurnani B, Kaur K. Comment on “Proposed measures to be taken by ophthalmologists during the coronavirus disease 2019 pandemic: Experience from Chang Gung Memorial Hospital, Linkou, Taiwan”. Taiwan J Ophthalmol [Epub ahead of print] [cited 2021 Dec 8]. Available from: https://www.e-tjo.org/preprintarticle.asp?id=315272



Dear Editor,

We are all aware that the coronavirus pandemic has affected the regular patient flow and practice patterns in all the specialties worldwide including ophthalmology. Since SARS-CoV-2 is highly contagious, we as ophthalmologists are at the highest risk of contracting this virulent infection, due to the close contact with patients during ocular examinations, and are also facing high patient volume in both the outpatient clinics and emergency consultations.[1] We read the interesting article by Lin et al.[2] and we were deeply impressed by the measures taken by the team for combating the coronavirus pandemic. We must congratulate the authors for highlighting all the measures during the past 9 months. However, we have a few important observations and suggestions to make and we would like the authors to share their experience with the readers.

First, in the hospital policy, the authors mention that “all visitors were screened by infra-red thermometers and were requested to put on masks before entering our hospital.” Did all the patients were also instructed for handwashing and sanitation before entering the hospital, as coronavirus is known to spread through the contact?[3] This needs clarification as this is missing.

Second, the authors mention that “patients with nonurgent ocular conditions or examinations will also be rescheduled and postponed to at least 1 month later.” It will be interesting to know that did these patients were initially teleconsulted[4] or based on history alone they were rescheduled for the next appointment. This also needs clarification.

Third, for “segregating patients and medical staffs” what strategy did the authors employ for examining pediatric patients as they are always accompanied by the parents? Were both parents allowed or single parent? This will be interesting to know. Moreover, since the patient volume was low, in a majority of the ophthalmology hospitals in our country, the doctors and nurses were segregated in 2–3 teams to reduce the contact and exposure time. The teams worked for 2–3 days a week during the pandemic.

Fourth, how did the authors manage to disinfect the fundoscopy, indirect ophthalmoscopy, and gonioscopy lenses after each examination? Did they use alcohol-based hand rub? Were these lenses washed after each examination? Were they also covered with disposable plastic wrap? These are very important questions in this context to know.

Next, before surgical intervention, did the high-risk patients underwent COVID-19 testing for antibodies or polymerase chain reaction as there is a high risk of spread in the operating room through aerosols? Moreover, did only the senior ophthalmologist perform the surgeries? This strategy is employed at the majority of the centers in our country to date to reduce patient table time and complication rate and it has proven beneficial during this pandemic.[5]

Finally, how did the authors manage the large corneal perforations and nonresolving corneal ulcers during the pandemic lockdown as there was an acute shortage of donor buttons? These patients were at high risk due to the risk of secondary glaucoma, phthisis bulbi, and endophthalmitis, and saving the globe was a challenge.

In the end, we want to add a few important points. Conjunctivitis cubicles can be set up separately as there is recent evidence of SARS-CoV-2 in the tear fluid. Patients with nonurgent conditions can be managed with teleconsultation and the doctors and nurses can be split up in alternate day teams to reduce contact and exposure.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors declare that there are no conflicts of interests of this paper.



 
  References Top

1.
Chan WM, Liu DT, Chan PK, Chong KK, Yuen KS, Chiu TY, et al. Precautions in ophthalmic practice in a hospital with a major acute SARS outbreak: An experience from Hong Kong. Eye (Lond) 2006;20:283-9.  Back to cited text no. 1
    
2.
Lin JY, Kang EY, Yeh PH, Ling XC, Chen HC, Chen KJ, et al. Proposed measures to be taken by ophthalmologists during the coronavirus disease 2019 pandemic: Experience from Chang Gung Memorial Hospital, Linkou, Taiwan. Taiwan J Ophthalmol 2020;10:80-6.  Back to cited text no. 2
  [Full text]  
3.
Khanna RC, Honavar SG. All eyes on coronavirus-What do we need to know as ophthalmologists. Indian J Ophthalmol 2020;68:549-53.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Jayadev C, Mahendradas P, Vinekar A, Kemmanu V, Gupta R, Pradhan ZS, et al. Tele-consultations in the wake of COVID-19-Suggested guidelines for clinical ophthalmology. Indian J Ophthalmol 2020;68:1316-27.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Sengupta S, Honavar SG, Sachdev MS, Sharma N, Kumar A, Ram J, et al. All India Ophthalmological Society-Indian Journal of Ophthalmology consensus statement on preferred practices during the COVID-19 pandemic. Indian J Ophthalmol 2020;68:711-24.  Back to cited text no. 5
[PUBMED]  [Full text]  




 

 
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