How the global pandemic has affected

What comes next after COVID-19

Ophthalmologists are facing their greatest ever challenge. EuroTimes Executive Editor Colin Kerr looks at what the future may hold

At the time of writing this article all routine clinical activity, outpatient clinics and surgery has stopped for most ophthalmologists. Some patients may receive treatment for emergency vitreoretinal surgery, intravitreal injections for macular degeneration and trauma cases, but as the number of patients requiring treatment for illnesses caused by COVID-19 increases, this will change.

Since the outbreak of the virus in Europe, EuroTimes has run a series of articles on eurotimes.org detailing the experiences of individual ophthalmologists in some of the countries worst hit by the virus.

In this issue of EuroTimes, key opinion leaders in European ophthalmology offer some hope for the future. This article summarises some of the key points they have raised.

ARTIFICIAL INTELLIGENCE When ophthalmologists return to normality, or as close to normality as possible, they will need extra resources and support to help them adjust to the new model of post-COVID healthcare. Artificial Intelligence solutions and supports will become increasingly important in the weeks, months and years ahead. That does not mean that ophthalmologists will become obsolete, as Professor Béatrice Cochener-Lamard pointed out in EuroTimes. (EuroTimes Sept 2019: Vol 24; Issue 9; pp 4-7).

Prof Cochener-Lamard suggested that it should be up to doctors to define the mission to be fulfilled by AI. “That mission should be to assist in diagnosis and to ensure remote expertise with proposals

for aetiology or decision-making. It is also important that we have guidelines, which will depend on the ethical rules and regulations of individual countries. No one stops progress; it is up to us doctors to do everything to support and control it,” she said.

HARMONISING HEALTHCARE POLICIES As the President of the ESCRS,

Professor Rudy MMA Nuijts, has pointed out, one thing that we have learned from the current crisis is that EU member states are not harmonised in their healthcare policies.

“Hopefully this crisis will provoke a paradigm shift for the future and lead to the level of solidarity and co-operation that we now already see on a micro level in our hospitals,” says Prof Nuijts.

HOMEWORKING Physical distancing is one of the key strategies in preventing the spread of the virus. This has forced some ophthalmologists and their staff to work from home. While the majority of ophthalmologists, practice nurses and administrative staff will return to work, some may decide that home-working is a more effective way of carrying out their daily functions. If remote contact with patients, including teleconferencing, is introduced, this may become a model for some practices in the future.

LEADERSHIP One of the key messages from recent months has been the importance of leadership and teamwork. Ophthalmologists have had to multi-task and take on roles that they would not previously have taken on in the past. While some doctors will be content to revert to their former roles in the future, others will be expected to take up leadership positions and to introduce new ideas and new ways of approaching ophthalmology.

The ESCRS Practice Management And Development Programme at the 38th Congress of the ESCRS in Amsterdam, The Netherlands, will include a special module on leadership.

“This period of great uncertainty will, I hope, lead to the opportunity and stimulus for innovation,” said Paul Rosen, Consultant Ophthalmic Surgeon at the Oxford Eye Hospital and Chairman of the Trustees of ESCRS and a former President of ESCRS. “Out of this adversity and tragedy we have to create opportunity, opportunity for people to excel, to show leadership, to innovate and to demonstrate what we can do for our fellow mankind.”

Hopefully this crisis will provoke a paradigm shift for the future and lead to the level of solidarity and co-operation that we now already see on a micro level in our hospitals Rudy MMA Nuijts MD, PhD

lists both in public and private practice, as they try to deal with the backlog caused by cancelled appointments. In some cases, patients will have formally contacted their ophthalmologist to inform him or her that they will not be presenting for treatment.

A bigger problem is dealing with those patients who had underlying conditions but who decided not to contact their ophthalmologist in the knowledge that COVID-19 was swamping the healthcare system. This means that eye surgeons, who have been working around the clock in some cases on medical emergencies arising from COVID-19, may be overwhelmed by the pressure of dealing with the post COVID overflow. This will require significant investment in ophthalmology from national governments once hospitals and clinics reopen.

PUBLIC AND PRIVATE MIX AFTER COVID-19 OUTBREAK Ophthalmology will return after COVID-19 but health administrators are likely to demand more co-operation between public and private clinics in the future. Ophthalmologists in both public and private practice may also need to recruit extra staff to deal with increased demand. “When clinics return to full opening, we will have to catch up with everything that has been delayed; cataract surgeries, vitrectomies and so on. We are already making plans for doing extra clinics and weekend surgery when this happens, though of course staff will need time off after the crisis so a lot of preparation will be needed,” says Carroll Webers MD, PhD, head of the University Eye Clinic Maastricht in The Netherlands.

RESEARCH Research has effectively been suspended in most countries as the treatment of COVID-19 cases takes priority. This situation cannot continue effectively and steps will have to be taken not only to deal with the backlog of research cases suspended since the outbreak of COVID19, but ophthalmologists will also need to develop new research projects which will help them to deal with other viruses and other health emergencies in the future. In the meantime, the Journal of Cataract and Refractive Surgery is continuing to publish new research papers.

TRAINING While formal training is on hold, young ophthalmologists will need support after COVID to allow them to resume their studies and take their exams.

Bruce Allan, consultant ophthalmic surgeons at Moorfields, UK offers some words of encouragement: “I am telling the trainees what I always have – you never stop learning, and while everything is on hold academically, there are plenty of really good resources online. Now is actually a very good time to put the hard yards in for the professional exams (when they come back).”

WHAT LIES AHEAD? Finally, although there may be very difficult and very sad months ahead, the pervading message from the ophthalmologists that EuroTimes has interviewed is one of optimism. Sorcha Ní Dhubhghaill, Anterior Segment Ophthalmic Surgeon at the Netherlands Institute for Innovative Ocular Surgery (NIIOS) and Antwerp University Hospital says:

“As this tragedy unfolds, I have found a source of optimism and strength in the way this is bringing people together. My hope is that you too will find such pockets of strength, hope, and resilience, that will allow us to weather this storm together.”