What have we learned thus far, months into the coronavirus pandemic? That is what James Chodosh, MD, MPH, addressed during the “Infection: Beating Back the Bugs” session (Cor05V) at Cornea Subspecialty Day. He presented the latest on SARS-CoV-2, the virus behind coronavirus disease 2019 (COVID-19). “Perhaps it should be COVID-19, 20, and 21 — we’ll see,” he said. Dr. Chodosh spearheaded the Academy’s coronavirus task force, generously sharing his expertise with the ophthalmic community since early March.
Virus characteristics. The well-documented spikes on this enveloped, single-stranded RNA virus bind to ACE-2 receptors expressed in various organs. The virus attacks lung tissue, but it can also infect the brain, gastrointestinal tract, and kidney.
Ocular and systemic manifestations. SARS-CoV-2 appears to cause a transient and mild follicular conjunctivitis. There have also been unconfirmed reports linking the virus to pseudomembranous conjunctivitis and epithelial keratitis. While the list of general symptoms is well known and continues to grow, Dr. Chodosh emphasized that the elderly may show only lethargy and confusion, with none of the classic symptoms, but may still be seriously ill.
Cases continue to spike. While the number of cases continues to rise at an alarming rate, deaths—although increasing—have not reached levels commensurate with the number of cases. This is due, in part, to the heroic work done by health care staff in intensive care units. While no age group is immune to the virus, the elderly are at highest risk of death. Race and ethnicity are risk markers, with Hispanic communities disproportionately affected, and Black populations most at risk for death.
Test, test, test. Real-time polymerase chain reaction (RT-PCR) remains the gold standard for measuring the presence of viral RNA. Of note, patients may remain positive on RT-PCR for five weeks after disease onset, but a positive test does not necessarily mean that the patient is still infectious. Although the risk of a second COVID-19 infection is believed to be low, immunity likely wanes over time.
Personal protective equipment (PPE). While surgical masks are intended to protect those around you, N95 masks protects both you and those around you. However, Dr. Chodosh cautioned against using N95 masks with valves, as they do not filter outgoing air and do not protect your patients from you. If patients wear valved masks, they should place a surgical mask over it, or swap it out for an unvalved mask.
Recommendations for ophthalmic surgery. Every patient undergoing surgery should be placed in a surgical mask to prevent asymptomatic transmission. With patients who are negative for SARS-CoV-2 on RT-PCR testing, standard PPE—including eye protection—should suffice for surgical personnel. If RT-PCR results are positive, Dr. Chodosh recommends delaying surgery for six weeks. For urgent or emergent situations, operating room staff should wear N95 masks and eye/face protection. At this time, procedures such as phacoemulsification and penetrating keratoplasty are believed to carry a low risk of causing aerosolized virus. Because SARS-CoV-2 has not been cultured from the ocular surface, and very rarely from eyes with COVID-19–associated conjunctivitis, the risk of transmission to the ophthalmic surgeon is believed to be low.
Given the nature of their interaction with patients, are ophthalmologists at higher risk of contracting COVID-19? It appears the answer is no. “The initial panic among ophthalmologists that they were more susceptible than other specialists has not been borne out by hard evidence,” he said.
But a significant number of health care personnel have died from the disease, and Dr. Chodosh also took a moment to acknowledge these individuals. They include Li Wenliang, MD, the 33-year-old whistleblower ophthalmologist from Wuhan who was the first to raise the alarm about the coronavirus in late December. “I wish you all the very best in health,” he concluded. —Keng Jin Lee, PhD
Further reading. Bookmark the Academy’s COVID-19 page at aao.org/coronavirus.
Watch Cornea Subspecialty Day. If you are registered for AAO 2020 Virtual, you have access to the archived presentations on the virtual meeting platform until Feb. 15, 2021. Log in to the virtual meeting platform: Next, from the Lobby screen, select “Sessions” from the top navigation; click “Agenda” from the drop-down menu; and click on the “Friday” tab.
Financial disclosures. Dr. Chodosh: National Eye Institute: S; Santen, Inc.: L; Shire: C; US Food and Drug Administration: C.
Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.
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