How are eye examinations and treatments carried out in the COVID-19 era? What has changed and how is infection prevented?

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In order to maintain the health of patients and medical staff in the times of the COVID-19 pandemic, new safety rules have been introduced in clinics, clinics and medical centers.

In ophthalmic facilities, it is now possible to admit only enough patients at a time to maintain the recommended 1,5-meter separation distance between them. Before starting a visit or procedure, patients must undergo a temperature test, disinfect their hands and complete a special questionnaire that will enable the assessment of the degree of virus risk (it must provide information on symptoms, body temperature, being in the company of infected people, traveling).

All employees of the facilities are equipped with personal protective equipment, such as disposable gowns, protective gloves, masks and helmets. Regular disinfection of all places where coronavirus could spread should be carried out: door handles, chairs, countertops, coffee and water dispensers, toilets and handrails.

1. See also: Ophthalmological examination

Due to the requirements regarding social distancing and preventing the spread of the coronavirus, telemedicine services have been implemented in most ophthalmic facilities. These services are now expected to develop rapidly, and for some medical conditions, teleporting will be combined with subsequent office visits and tests. Unfortunately, in the case of ophthalmological consultations that require examination with the use of advanced devices, telepaths can only be used in special situations, usually in cases of continuing treatment. An example is the measurement of intraocular pressure (tonometry), which should be performed practically during every visit, and it is not possible to do it remotely.

General safety indications

During the entire visit, the patient should wear a mask that covers his mouth and nose, and should uncover it only at the request of the facility staff.

Surgical masks significantly reduce transmission of respiratory viruses, including SARS-CoV-2, from an infected person. Each patient should wear a surgical mask during ophthalmic surgeryto prevent possible asymptomatic transmission of the coronavirus to the surgeon and staff.

During diagnostic tests, and especially with the slit lamp, patients are asked not to talk to a healthcare professional. The equipment is disinfected before and after each examination (slit lamp, Goldman tonometer, three-mirror). Special transparent protective pens have been installed next to the slit lamps, which separate the patient from the doctor. It is a solution that reduces the risk of aspiration by a doctor, the so-called aerosol, potentially containing SARS-CoV-2 particles. In the case of other devices, it is recommended to keep the separation between the patient and medical staff. It is recommended that the ocular pressure is measured with an applanation tonometer with disposable sterile tips to eliminate the risk of contamination. The most frequently used tonomers generate a blast of air that generates a potentially dangerous aerosol.

1. Find out more: How to protect your eyes from COVID-19 infection?

Sanitary and epidemiological regime in operating theaters

Treatments are carried out under a strict sanitary and epidemiological regime, in accordance with EU standards. UVC lamps are used in treatment rooms, rooms for the preparation of patients for the procedure and in the operating room, which disinfect the air within their emission range.

He should be in the operating theater ventilation and air conditioning system, which includes HEPA filters. It allows for the effective removal of fungal cells, bacteria and many unwanted viruses from the air. The intervals between treatments should be extended in order to completely exchange the air. After the procedures, patients should stay in separate, single rooms or at a distance of at least 2 m. For these reasons, it is recommended to reduce the number of operations performed per time unit to 70% compared to the situation before the pandemic.

Iodine is used for local disinfection and preparation of the treatment site, which is effective against coronaviruses. The formation of aerosols is likely during all procedures, especially in the case of cataract phacoemulsification. Unless the patient is tested for SARS-CoV-2 immediately prior to surgery, the use of an FFP3 mask and face shield for the surgeon and staff is recommended.

The SARS-CoV-2 virus enters our body, e.g. via ACE2 receptors, which are found in abundance in the cells of the nose, lungs and intestines, which is why these organs are attacked first. Antibodies to SARS-CoV-2 generally appear in the patient’s blood within 1 to 3 weeks after infection, so a negative serological test does not rule out active infection.

Treatments and COVID-19

If a patient with a scheduled ophthalmic procedure has tested positive for SARS-CoV-2 or is in quarantine, he or she will be able to undergo surgery only about 6 weeks after receiving a negative result and disappearing all symptoms of the disease or confirming a negative result in the case of suspected disease.

A patient with a high probability of infection or with a confirmed SARS-CoV-2 infection should be isolated and transported from the medical facility to the emergency room of an infectious hospital.

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3. WHO Vision Report. Over a billion people have untreated visual disturbances

Have a question about the coronavirus? Send them to the following address: [email protected]. You will find a daily updated list of answers HERE: Coronavirus – frequently asked questions and answers.