Ophthalmology Clinics: Coping with COVID-19

As coronavirus continues its onslaught, the only certainty is that numbers of both cases and deaths will rise. With patients on lockdown and surgeries and procedures canceled to open up space for hospital beds, the long-term impact of coronavirus on ophthalmologists could be considerable.

Anxiety permeates the industry and the general population as governments and healthboards remain unable — or unwilling — to predict when this crisis will end. Lockdowns are now in effect in several countries while other nations have left it up to individual regions and states to decide on their own anti-virus policies. 

For example, India is now enforcing a total lockdown of its 1.3 billion citizens. At the same time, states in Brazil are deciding their own policies, while leaders in Hong Kong are looking to introduce even tougher quarantine measures. In any case, ophthalmologists in all three countries are certainly experiencing unprecedented challenges.

Clearly, there is no global conjoined effort to fight the virus.Therefore, PIE spoke with ophthalmologists from Hong Kong, India and Brazil — three countries with markedly different approaches to the coronavirus crisis — to learn more about the virus’s impact on both the community and clinical practice. And though these clinicians vary in specialty . . . they have all been affected by the pandemic.

Cutbacks in Care

“We were ready for the change, but we weren’t expecting it to last so long,” said Dr. Hudson Nakamura, a medical specialist in ophthalmology and a vitreoretinal fellowship professor at the Brazilian Center for Eye Surgery.

“The system has kind of halted,” he said.

Dr. Nakamura’s clinic in Goiânia, Brazil, has been forced to make swinging cuts to its schedule and procedures. Patient care is down nearly 60% and surgeries have been reduced, with only emergency options permitted.

This includes cataract, retina and laser surgeries, among other procedures. Glaucoma patients requiring urgent intraocular pressure reductions are still undergoing surgery.

Strict social distancing procedures are now in place, with patients admitted to the clinic unaccompanied and one-by-one. Dr. Nakamura also reports widespread anxiety among his patients.

The effect on the clinic’s bottom line has been considerable too, as it relies on a sizable minority of privately insured patients. Most patients are referred through Brazil’s national health system. Despite the difficulties Dr. Nakamura is optimistic that his team will weather the storm.

“The system will get back to normal — we won’t be affected too much,” he said.

Borders and Medicine

Normalcy is still months or years away. This is best exemplified by the massive disruption to international travel caused by coronavirus. Airports are empty, runways are packed with unused aircraft and most countries have introduced travel restrictions or bans.

The border between Hong Kong and mainland China is normally one of the busiest in the world. Some restrictions were introduced in February, but on March 25 all foreigners and non-residents were banned from entering Hong Kong.

Dr. Wai-Ching Lam is one of the many affected Hong Kongese. A clinical professor at the University of Hong Kong, Dr. Lam is a retina specialist at the University’s campuses in Hong Kong and Shenzhen. Now, he cannot travel to Shenzhen due to quarantine restrictions, forcing him to resort to telemedicine.

“Clinical service was reduced to 50%, so most regular check-ups were postponed; elective surgery was reduced to 30% for the local anesthesia cases,” said Dr. Lam. “General anesthesia is only for urgent and emergency cases. All high-risk procedures such as oculoplastica, dacryocystorhinostomies, etc., were canceled.” 

Economics and Eyecare

After seeing a rise of cases in India, Hong Kong closed its borders to preempt an explosion. Thus far, India has seen a smaller number of coronavirus cases ( just over 1,200). However, that number will rise exponentially.

Most non-emergency clinics are now shut down, including the Arunodaya Deseret Eye Hospital led by Dr. Arun Sethi. Based in Gurugram, Haryana, the hospital is part of the Team Arundaya network,  including another clinic based in Delhi.

Team Arunodaya is limiting itself to emergency procedures at its Delhi clinic — they are not performing glaucoma or cataract surgeries.

Dr. Sethi’s concerns are mainly focused on the outcome of the coronavirus, rather than its current impact. He fears a global shortage of medical and ophthalmological equipment in the coming years, despite not personally experiencing any shortages at present, as the primary manufacturer of this equipment is China.

“There are still a lot of cases for China to answer for…the equipment manufacturers are now enjoying a monopoly,” he said.

“We need more transparency” he said, emphasizing that the true cost of the virus will be economic as much as social.

Times, They are a Changin’

This cost will also include financial and emotional damage. Though policies vary by country and clinic, it is apparent that thousands of patients will continue to suffer from serious and chronic conditions like cataracts and glaucoma for longer than would otherwise be the case.

Many ophthalmological professionals believe the industry will return to normal when coronavirus dissipates. International cooperation will continue and border restrictions will be rescinded when they lose their efficacy.

The legacy of the virus may be in altered working practices. According to Dr. Lam, clinics will retain many of the current social distancing methods.

“We will be more vigilant in hygienic precaution, with consistent cleansing and hand washing between patients,” Dr. Lam said, adding a note of hope. “For ophthalmology, long-term, I don’t think there will be that much of an impact, as the need for patient care will still be there,” he said.