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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.

Dr. Wai Ching Lam

About the Contributing Doctors

Professor Wai-Ching Lam is a clinical professor, and the Albert Bing-Ching Young Professor, in ophthalmology at the University of Hong Kong. He is the chief of service of the Department of Ophthalmology, University of Hong Kong Shenzhen Hospital. He joined the academic staff at the Department of Ophthalmology and Vision Sciences, University of Toronto in 1996. He was involved in all aspects of medical education in the department; he took on the post of the vice chair of education (2013-2016), continuing education director (1996-2016), and residency program director (2001-2013). He has also been the vitreo-retinal fellowship director for the University Health Network/Sunnybrook Health Science Center, University of Toronto (2002-2016). Professor Lam is a vitreo-retinal surgeon with clinical interests in adult and pediatric retinal diseases. His research areas are age-related macular degeneration, diabetic retinopathy, pediatric retinal disease areas, retinopathy of prematurity, etc. For his clinical and scientific work, he received the Achievement Award from the American Academy of Ophthalmology and Asian Pacific Academy of Ophthalmology, and the Senior Honor Award from the American Society of Retinal Specialists. He is interested and involved in medical education and won numerous teaching awards from both the Faculty of Medicine and the Department of Ophthalmology, University of Toronto.

Dr. Hudson Nakamura

Professor Hudson Nakamura is an ophthalmologist specializing in retina and vitreous. He did his vitreoretinal disease fellowship at the University of Toronto, Canada, and another retinal fellowship in his hometown city, Goiânia, Brazil at the CBCO – Brazilian Center for Eye Surgery. Prof. Nakamura completed his study from the School of Medicine at the Federal University of Goiás and residency from the Base Hospital of the Federal District, Brasília, Brazil. He has been a member of industry organizations including the American Academy of Ophthalmology, Brazilian Council of Ophthalmology, Canadian Society of Ophthalmology and the Association for Research in Vision and Ophthalmology. He is currently working as a professor in the Department of Retina and Vitreous Course of Medical Residency in Ophthalmology and Fellowship in Vitreoretinal Diseases. [Email: hudson.nakamura@alumni.utoronto.ca]

Dr. Arun Sethi

Dr. Arun Sethi joined Arunodaya Deseret Eye Hospital as Medical Director. He has been practicing in the field of community ophthalmology and refractive surgery (LASIK) for 30 years and has performed thousands of surgeries and lasers. Dr. Arun Sethi is credited with pioneering the work in community ophthalmology in Gurgaon and Delhi, NCR. Dr Arun Sethi has continued to remain actively involved in research and medical education. In addition to his numerous publications and presentations, he has been invited to deliver lectures and keynote addresses at many National and International conferences. He has participated in numerous national & international meetings as faculty, instructor and guest lecturer including Faculty at American Society of Cataract and Refractive Surgery (ASCRS), International Association of Prevention of Blindness (IAPB), Russian Ophthalmic Society, All Indian Ophthalmic Society (AIOC), Delhi Ophthalmic Society (DOS) and many more

He has also won several accolades for his work in Community Ophthalmology, including the prestigious Life Time Achievement Award at his alma mater, St. Xavier’s School, Delhi. He has held prominent positions in several ophthalmic societies including the All India Ophthalmological Society and the Delhi Ophthalmologic Society. He is a Senior Ophthalmic Consultant to hospitals such as Fortis Memorial Hospital, Gurgaon and Indraprastha Apollo Hospital, Delhi

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Dr Manisha Chilvade
3 months ago

A very informative article written after extensive interview and in depth analysis.

Dr parul lokwani
3 months ago

the assesment of Dr Arun sethi, bears a major impact on the economics of Ophthalmic practice in the developing countries, especially India.

Kevin peter
2 months ago

Asia Pacific Conferences heartily welcomes you to the most prestigious 4th International Conference on Ophthalmology from August 07-08, 2020 Osaka, Japan

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