Protective measures for ophthalmic practices amidst COVID-19 pandemic

The authors of this paper discuss how to mitigate the clinical risks to patients, providers and the public during the COVID-19 pandemic.

Study design

Due to the rapidly growing number of COVID-19 cases worldwide, state and federal authorities are instituting measures to contain, suppress and mitigate the pandemic. The authors discuss measures that can be taken to protect both patients and medical professionals.

Outcomes

The recommended clinic management measures include:

• Contact patients prior to appointments to ensure they do not have concerning symptoms such as fever, cough or sore throat
• Limit all nonurgent elective care to mitigate clinical crowding
• Implement telemedicine when appropriate
• Use of PPE if seeing a patient with respiratory symptoms and urgent/emergent ocular concern
• Require on-site temperature screening and regular hand hygiene for both patients and doctors

During ophthalmic exams, the face-to-face proximity of slit lamp biomicroscopic examination may place ophthalmologists at a higher risk of aerosolized particles. For symptomatic persons under investigation or those with a confirmed COVID-19 diagnosis, a mask for the patient and full PPE for the provider including a single-use N95 mask and eye protection, is required.

Limitations

Given the variations in practice patterns, an international consensus is necessary to create evidence-based guidelines. As knowledge of COVID-19 transmission evolves, more clarity is needed on clinic flow optimization, instrument cleaning protocols and the appropriate use of PPE under different circumstances.

Clinical significance

Ophthalmologists need to stay highly vigilant to recognize early manifestation of COVID-19. This includes considering viral conjunctivitis as a possible presentation.