Clinical workflow and operations have been significantly impacted by the outbreak of COVID-19. Our practice, like many others, has seen measurable reductions in clinical volume as well as changes in the types of surgeries we perform. Although we have recently started to open up to performing non-emergent surgical procedures, we must adopt a post-COVID-19 awareness about our risks. Additionally, we anticipate a potential surge in surgical cases as general ophthalmology and optometry practices fire back up and patients begin to feel comfortable seeking medical care.
As we begin to assess what the “new normal” will look like for surgical retinal practice, I have been involved in many conversations with colleagues about maintaining safe conditions in the OR for physicians, patients, and staff. From initial studies, ophthalmology is among the top 5 specialties that are at the highest risk. The nature of the work we do elevates the risks: ophthalmologists operate near the head of the bed in close proximity to patients’ faces and mouths for an extended period of time, and we are often dealing with older patients with concomitant and immune-compromising conditions. Coupled with the potential for transmission from asymptomatic patients, there are numerable opportunities for disease to spread in the OR. Even with standard pre-operative COVID-19 testing, results from testing varies from 24 to 96 hours of turnaround, leaving a potential window for patient exposure prior to their surgery.
Needless to say, these factors have forced us to change a lot of what we do on surgical days. Pre-operative COVID-19 testing has become standard at many hospitals and ambulatory surgery centers, with COVID-19 positive patients being operated on at hospitals equipped for these cases. The American Society of Retina Surgeons (ASRS) released a statement highly recommending wearing an N95 mask with surgical mask over it, wearing eye protection (although this is difficult to see with the microscope), and having patients wear a surgical mask under drapes. However, despite this, I, along with others, have still observed binocular indirect ophthalmomicroscope condensation rhythmic with patients’ breath, indicating that despite best practices, there is still air flow that can escape.
COVID-19: Telemedicine in RetinaWatch this New Retina Radio episode where host John Kitchens, MD, dives into a conversation with S.K. Steven Houston III, MD; John B. Miller, MD; and Ehsan Rahimy, MD, to understand telemedicine’s viability and durability during and beyond the COVID-19 era.
We have realized that some of the unique features of the NGENUITY 3D Visualization System (Alcon) may be an asset to help enhance safety. For example, ocular-based viewing creates a challenge for wearing a face mask and eye protection during surgery. With the display monitor used with NGENUITY, I have found that I can comfortably wear a face mask that has been modified to accommodate an eye slit, with the 3D glasses worn underneath. Notably, we are currently experimenting with a specially designed full-face shield with the 3D film overlying the entire mask to allow for a fully enclosed protective face shield, one that could even accommodate the use of powered air purifying respirators for COVID-19 positive cases, if needed. As an additional consideration, fellows, residents, assistants, and attendings in the room are no longer looking through sidescopes, thereby maintaining a safer distance from the patient as they can stand back from the surgical field and still have the same “surgeon view” while reducing close exposure that may entail undue risk. We are also developing solutions to live stream digital 3D video to other devices from the OR to allow telementoring and teleeducation. Finally, we are developing novel “other personal protective equipment ” solutions aimed to help enhance the safety and reducing the risk of exposure for the surgeon and patient during procedures.
I, like many of my colleagues, remain optimistic that there will be a return to some semblance of normalcy at some point in the future. However, when or even if that will occur is really unknowable. Therefore, during these uncertain times, technology can be an asset in establishing safer working conditions for staff and physicians. We can and should educate patients about how we are using these measures to help assuage their concerns as well. In my mind, NGENUITY has added to my comfort in the OR as I feel I am able to wear the appropriate personal protection equipment while still doing my cases, and anyone else who is going to be in the room during the surgery can use the display screen to stay at a safe distance or even outside the OR and still have an immersive and valuable experience.
The difficult and unusual circumstances that we are all dealing with are challenging us to adapt and develop new ways of doing things to help protect ourselves and others. That sentiment is really inclusive of what we do in the OR. Our practice’s decision 2 years ago to adopt digital viewing has therefore provided us a platform we can use to develop safer surgical protocols so that we can continue to deliver services for patients.
Participants are paid consultants of Alcon.