Sustainability of Ophthalmology Practice and Training During and Post the Pandemic of Coronavirus (COVID-19): A Review

Figures & data

Figure 1 Flow chart of patients in ophthalmology clinics. Note: Reproduced from Ophthalmology practice during the COVID-19 pandemic, Safadi K, Kruger JM, Chowers I, et al., 5, e000487, copyright 2020] with permission from BMJ Publishing Group Ltd.⁶

Figure 2 Registration workflow for outpatients and inpatient. Blue letter referral: inpatient interdisciplinary referrals to outpatients to be seen after 9:30 AM. Note: Reprinted by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Graefe's Archive for Clinical and Experimental Ophthalmology, Sustainable practice of ophthalmology during COVID-19: challenges and solutions, Lim LW, Yip LW, Tay HW, Ang XL, Lee LK.  Copyright 2020.⁷

Figure 3 Flowchart of the patient triage protocol. Note: Copied from COVID-19: limiting the risks for eye care professionals, Sadhu S, Agrawal R, Pyare R, et al., Ocular Immunology and Inflammation, 2020 Taylor & Francis, reprinted by permission of the publisher (Taylor &Francis Ltd, http://www.tandfonline.com).⁸

Figure 4 Decision tree in the eye clinic during the COVID-19 pandemic. Note: Reproduced from Gharebaghi R, Desuatels J, Moshirfar M, Parvizi M, Daryabari SH, Heidary F. COVID-19 preliminary clinical guidelines for ophthalmology practices. Med Hypothesis Discov Innov Ophthalmol. 2020;8(2):149.⁹

Figure 5 Decision tree in the ophthalmic outpatients’ clinic during the COVID-19 pandemic. Note: Data from Romano MR, Montericcio A, Montalbano C, et al. Facing COVID-19 in ophthalmology department. Curr Eye Res. 2020;45(6):653–658. doi:10.1080/02713683.2020.1752737.¹⁰

Figure 6 Patient triage in ophthalmology outpatient clinic.

Abbreviations: A&E, Accident and Emergency Department; TOCC, travel, occupation, contact, and clustering. Note: Reprinted by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Graefe's Archive for Clinical and Experimental Ophthalmology, Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong, Lai TH, Tang EW, Chau SK, Fung KS, Li KK. Copyright 2020.¹¹

Table 1 The Strengths and Shortfalls of the Six Introduced Protocols

Protocol	Strengths	Shortfalls
Israel^Citation6	Ocular clinical care for the suspected COVID-19 patients (only high temperature >38° C) Restricted in clinic procedures Telemedicine technology	Temporary protocol Limited screening measurements No Artificial intelligence (AI) No advance diagnostic, inpatients and surgery procedures protocols No staff feedback
Singapore^Citation7	Partially permanent protocol Restricted screening to identify the COVID-19 cases for the patients and their accompanying Restricted in clinic procedures Outpatients and inpatients protocols Ocular clinical care for highly suspected COVID-19 patients Staff feedback	No technology (AI or Telemedicine)
Not specified^Citation8	Ocular emergency protocol Restricted in clinic procedures Ocular clinical care for highly suspected COVID-19 patients	Temporary protocol No technology (AI or Telemedicine) No advance diagnostic, inpatients and surgery procedures protocols No staff feedback
Iran^Citation9	Ocular emergency protocol Restricted in clinic procedures Telemedicine technology	Temporary protocol No Artificial intelligence (AI) No advance diagnostic, inpatients and surgery procedures protocols No ocular care for suspected COVID-19 patients No staff feedback Postpone non-urgent cases
Italy^Citation10	Restricted in clinic procedures Telemedicine technology Ocular clinical care for tested COVID-19 patients Two separate groups of staffs (one for positive COVID-19 patients and one for negative COVID-19 patients)	Temporary protocol No Artificial intelligence (AI) No immediate ocular care for suspected COVID-19 patients No advance diagnostic, inpatients and surgery procedures protocols No staff feedback
Hong Kong^Citation11	Restricted screening to identify the COVID-19 cases for the patients Restricted in clinic procedures Ocular emergency protocol Ocular non-emergency protocol	Temporary protocol Long screening process No technology (AI or Telemedicine) No advance diagnostic, inpatients and surgery procedures protocols No staff feedback

Table 2 Protective Measures Adopted in 6 Different Eye Hospitals and Clinics Internationally to Mitigate the Risks of COVID-19

	Healthcare Workers							Patients
Location	Gloves	Face Mask	Gown	Slit-Lamp Shield	Temperature Screen	Goggle	Survey	Face Mask	Temperature Screen	Patients Accompanying Protection	Isolation Room	Screening Questions
Israel^Citation6	√	√	√	√	√	√	X	√	√	X	√	√
Singapore^Citation7	√	√	√	√	X	√	√	√	√	√	√	X
Not specified^Citation8	√	√		√	X	X	X	√	X	X	√	√
Iran^Citation9	√	√	√	√	X	√	X	√	√	X	X	√
Italy^Citation10	√	√	√	√	X	√	X	√	√	X	√	√
Hong Kong^Citation11	√	√	√	√	√	X	X	√	√	√	√	√

Note: √ = yes, X = no.

Safadi K, Kruger JM, Chowers I, et al. Ophthalmology practice during the COVID-19 pandemic. BMJ Open Ophthalmol. 2020;5(1):e000487. doi:10.1136/bmjophth-2020-000487

 PubMed Web of Science ®Google Scholar

Lim LW, Yip LW, Tay HW, Ang XL, Lee LK. Sustainable practice of ophthalmology during COVID-19: challenges and solutions. Graefes Arch Clin Exp Ophthalmol. 2020;258(7):1427–1436. doi:10.1007/s00417-020-04682-z

 PubMed Web of Science ®Google Scholar

Sadhu S, Agrawal R, Pyare R, et al. COVID-19: limiting the risks for eye care professionals. Ocul Immunol Inflamm. 2020;28(5):714–720. doi:10.1080/09273948.2020.1755442

 PubMed Web of Science ®Google Scholar

Gharebaghi R, Desuatels J, Moshirfar M, Parvizi M, Daryabari SH, Heidary F. COVID-19 preliminary clinical guidelines for ophthalmology practices. Med Hypothesis Discov Innov Ophthalmol. 2020;8(2):149.

 Google Scholar

Romano MR, Montericcio A, Montalbano C, et al. Facing COVID-19 in ophthalmology department. Curr Eye Res. 2020;45(6):653–658. doi:10.1080/02713683.2020.1752737

 PubMed Web of Science ®Google Scholar

Lai TH, Tang EW, Chau SK, Fung KS, Li KK. Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong. Graefes Arch Clin Exp Ophthalmol. 2020;258(5):1049–1055. doi:10.1007/s00417-020-04641-8

 PubMed Web of Science ®Google Scholar