Inside Ophthalmology

Lockdown Loco

Operating on patients during the COVID-19 pandemic is opening up new challenges for ophthalmologists. Dr Clare Quigley reports

Lockdown loco, we with a drysdale instead of my say. It’s our term usual chopper, minimal phaco for the creeping required. In and out in under lockdown-induced ten minutes. cabin fever we are The latter case was tricky. fighting; my husband and I She was a 97-year-old lady, are cutting each other some who was profoundly deaf, slack. He can go play games but seemed calm and able online with his friends, I am for surgery under local allowed to binge on Netflix anaesthetic. I gave her written occasionally. As it is, at the instructions, and she seemed to time of writing this article understand what was required. in October, we cannot move On the table though, after a outside county Dublin. promisingly quiet start, she did

We had plans. There was not stop moving her head and to be a trip to the west of talking. Complicating matters, Ireland to visit my mother, she had a tiny pupil that did who would mind Michael not respond to intracameral while I logged into the ESCRS phenylephrine, and a dense meeting. Trip cancelled due cataract. A Malyugin ring to evolving restrictions. At brought up her pupil to give least we could still see family adequate access, and I enlisted and friends in Dublin... for a the scrub nurse to clamp his while. The government has now advised against visiting other people’s homes. But we try to focus on the positives. Michael sleeps better now, a very welcome development. Also, we live near the Phoenix Park, an extensive urban park Illustration by Eoin Coveney hands on her temples – I got through it okay in the end, after more than half an hour, but we both said we wouldn’t like to do it again. Work is more than cataracts – until early next year I will be on the glaucoma team, that’s home to Dublin zoo. In the zoo, an outdoor safari trail has remained open for now. We had plans. There was to be a trip to the west of Ireland to visit my mother, training under Consultants Jeremy O’Connor and Aoife Doyle. The days begin with We brought Michael there for a visit – at 11 months he is a bit young for the zoo, who would mind Michael while I logged into the ESCRS meeting a ward round, followed by a mix of clinic and theatre sessions. I see complex patients maybe it was more ourselves in their clinics; my decision we were taking for the outing process about which patients – but he was captivated by one of the animals, a red panda. need a trabeculectomy, and who could get by with laser or Red pandas are small, furry creatures native to the Himalayas, drops, is becoming more refined. Getting to know the visual like a cross between a raccoon and a fox. One padded right field progression analysis software has helped, but more by Michael as he followed it wide-eyed, watching through the importantly the relatively quiet clinics mean I can have a glass until it was out of sight. Trips to the Phoenix park, and good discussion on cases with the consultants; compared to the other parks close by, feel precious at the moment. The normal times, the clinic numbers are halved, to comply with trees are brilliantly lit up in shades of red, orange and yellow the social distancing measures. We don’t like to imagine how for another short while. half the patients who used to attend regularly are getting on

Clinical activities in the Royal Victoria Eye and Ear without a review... as a mitigating measure they have opened Hospital – or the Eye and Ear as we call it – are still up and a new drive-through IOP clinic for suitable patients. Patients running, as a second wave of COVID is breaking. Patients get a quick iCare pressure check, without even exiting their attend for cataract surgery, and I’ve been getting back into the car. It’s not a clinic visit with a visual field, but it’s something. rhythm of operating. In one week I did my fastest, and one of Infection rates may worsen, and elective surgeries and my slowest cataract surgeries. The former case was a myopic clinics may grind to a halt again. I try not to think about that. woman in her fifties with posterior subcapsular cataract, who Or the health budget, and how much it will likely contract was quite nervous. The anaesthetist gave a good subtenons over the next few years – when I will be due to finish training block and some sedation. I saw that the cataract looked soft, – new consultant ophthalmologist jobs are already sporadic and that her anterior chamber was nice and deep; I could take at best... Thinking about that too much, it would be easy to my usual soft lens approach. go lockdown loco.

After making a generous rhexis I was able to pop up the lens on hydrodissection, so it sat vertically half in, half out of the Clare Quigley is a resident at the Royal Victoria Eye and Ear bag. From there I aspirated in the iris plane, spinning the lens Hospital, Dublin, Ireland