The response to the pandemic could advance

COVID-19 lessons

Virus response could change – and advance – ophthalmic practice permanently. Howard Larkin reports

Technology solutions spurred by the need to contain the spread of SARS-CoV-2, the virus causing COVID19, could permanently change the way ophthalmology is practiced, Bahram Bodaghi MD, PhD, FEBO, told the 38th Congress of the ESCRS Virtual. Ophthalmologists have a particular interest in the virus because the conjunctiva is a potential entry point, and eye exams can expose clinicians to patients’ faces for extended periods.

As a result, online services, artificial intelligence and even robots have begun changing everything from how patients check in to how and where visits are conducted, said Dr Bodaghi, who is chair and professor of Ophthalmology & Visual Sciences at Sorbonne University, Paris, France. “Modern technologies are game changers and diagnostic processes may be decentralised.”

RISKS AND STRATEGIES The potential stakes for ophthalmologists are as high as they can be. Dr Bodaghi began his presentation on COVID19 lessons learned with a tribute to Li Wenliang MD, the heroic Chinese ophthalmologist known for blowing the whistle on the novel coronavirus in December 2019. He succumbed to COVID-19 on 7 February 2020.

“He gave his life in the front line of the viral war,” said Dr Bodaghi, who encouraged young physicians to follow Dr Li’s example of fearless public service. He also honoured Prof Yuri Astakhov MD and Dmitry Yarovoy MD, both of Russia, who have died battling the coronavirus.

“I’m sure you all know friends and colleagues who contracted the virus and got ill or died.”

Looking back on previous disease outbreaks for guidance,

Modern technologies are game changers and diagnostic processes may be decentralised They are really important tools to protect us not only against COVID, but against other types or infections, especially during fall and winter

Bahram Bodaghi MD, PhD, FEBO

Dr Bodaghi noted the response to Creutzfeldt-Jakob variant prions, which caused the field to adopt many measures to avoid its transmission through the eye that brought other benefits.

“I don’t know how successful we were with Creutzfeldt-Jakob, but at that time we made a lot of progress in preventing adenoviral infections and transmission either to patients or ophthalmologists.”

Similarly, Dr Bodaghi observed that slit-lamp shields that are now ubiquitous because of coronavirus serve more than one purpose.

“They are really important tools to protect us not only against COVID, but against other types or infections, especially during fall and winter.”

Previous outbreaks, including SARS and the 1918 flu pandemic, teach us the importance of understanding waves. Using World Health Organization data, Dr Bodaghi suggested that the first wave has not yet ended in the Americas while in Europe a second wave is under way, with significant new outbreaks in Spain, France and elsewhere on the continent. Continued vigilance will be necessary, he added.

CORONAVIRUS AND THE EYE From the earliest research on COVID-19, the eye has been identified as a potential port of entry into the body, Dr Bodaghi said. Conjunctivitis is present in about 1% of cases (Guan W et al. N Engl J Med 2020; 382:1708-1720).

“What is also interesting is … eye protection may prevent person-toperson transmission,” with reduced odds of infection for people wearing eye protection (Chu D et al. Lancet June 2020;395: 1973-1987. Zeng W et al.) or wearing glasses for eight or more hours daily (JAMA Ophthalmol. Published online September 16, 2020).

Regarding potential ocular mechanisms of transmission, there are essentially two, Dr Bodaghi said. One is the conjunctiva itself, which has several receptors on its surface to which the virus can bind. The second is the canaliculus, which leads to the nose and the upper respiratory tract (Barnett B et al. Vision. 2020;4(3):40).

Some evidence suggests COVID-19 may affect the retina, though there is controversy about interpretation of the data. Shutdowns related to the pandemic also significantly reduced hospital revenues from elective surgeries as well as opportunities for training, Dr Bodaghi said.

Looking to the future, “we have to prepare ourselves to live with the virus for a while”, Dr Bodaghi said. Technology solutions, some already in use, will play a major role.

Telemedicine has taken off with many routine registrations, screening and follow-up visits now carried out remotely.

“It was of course present before but for sure it has more developed in asynchronous, synchronous and hybrid applications for seeing our patients. This is a real opportunity to permanently increase our capabilities,” Dr Bodaghi said.

He expects these applications to expand with remote diagnostic and AI applications powered by 5G mobile networks enabling more remote visits. Such technologies should be useful for addressing a second, third or fourth wave and any future coronavirus variants that may evolve. Robots that meet patients and help them through the measures they must take before being seen are another possibility.

“Overall, the first objective is to prevent transmission of viral infection, and then to adapt to the dynamic of the infection and prepare ourselves for the management of our non-COVID-19 patients,” Dr Bodaghi said.

“We must learn to live with the virus waiting for a spontaneous resolution or a vaccine.”