In Your Lane Ophthalmology and Society

Outgoing AAO leader calls for social as well as professional engagement. Howard Larkin reports from ASCRS in Las Vegas, USA

The past 18 months have been a time of testing filled with lessons for future growth, David W Parke II MD said at the ASCRS opening ceremony. In his final address to the membership, Dr Parke, who departs this year as CEO of the American Academy of Ophthalmology, urged ophthalmologists everywhere to become more fully engaged in their communities.

Responding to issues outside of eye care that affect public health, which includes not only the COVID-19 pandemic but related issues such as racism and the rise in drug abuse and depression, is essential to fulfilling the Academy’s professional mission of protecting sight and empowering lives, Dr Parke said. “We ultimately will only thrive if our communities thrive.”

COVID LESSONS The speed and magnitude of the pandemic’s onset revealed many weaknesses and some strengths in the preparations of the profession and society at large. It was not just a story of case numbers and deaths but of innumerable lives altered forever, Dr Parke said.

“Even though we now know the SARS-CoV-2 virus made it to the United States by late December 2019, the first confirmed US case was on January 28, 2020. It was still business as usual,” he remarked.

But by March 1, there were 30 confirmed US cases, ballooning to more than 10,000 by March 18. Initial mortality estimates were in the 2% to 3% range, prompting people to wipe down mail with disinfectant while waiting for hospitals to run out of ICU beds and ventilators. By May, 75% of hospitals reported exhausted stocks of essential personal protective equipment (PPE).

“It was not unreasonable fear. We were all facing the detonation of a global pandemic with uncertain but substantive mortality, no known treatments, and a nation running out of even basic masks and gloves,” Dr Parke said.

The only actions immediately available to combat the pandemic were to reduce transmission rates and preserve scarce PPE for frontline workers, Dr Parke said. So, on March 18, 2020, the AAO board recommended ophthalmologists cease providing non-urgent care to accomplish those ends.

While the statement called on individual practitioners to use their own judgement, “in an amazing show of professional unity, this statement was endorsed within days by most major organisations in ophthalmology, including ASCRS, the Cornea Society, and the American Glaucoma Society. Within days, most other specialties issued similar statements, as did the US Surgeon General and the CDC,” Dr Parke said.

As a result, most elective procedures and routine care shut down for months. Along with stay-at-home orders, the measures did slow the transmission rate. AAO advised on April 17 that practices could reopen based on local conditions. An abrupt and global shutdown reversed on a regional and gradual basis.

Some parts of the specialty, such as paediatric ophthalmologists, were affected more, while others, such as retina specialists, were affected less. During the shutdown, some ophthalmologists took training in life support to help out on the front lines. Others caught up on training, with CME requests increasing by 73%. Still, by the end of the year, surgical volumes were back to pre-pandemic levels or even a little higher, Dr Parke noted.

“If we knew in March 2020 what we know now, the March AAO statement might have been more nuanced,” Dr Parke said. But the episode contains an important leadership lesson.

“There are times when decisions must be made without the comfort of having all the data you’d like and without the luxury of lengthy debate,” he said. “In those circumstances, decisions must be guided by principles. Chief among them is that preserving human life and safety is paramount.”

COMMUNITY RESPONSE During the pandemic, other social issues emerged, including the murder of George Floyd in police custody and the subsequent rioting and unrest. These events prompted the AAO board to condemn racism, Dr Parke said. The statement drew three kinds of responses.

The overwhelming majority supported the position, Dr Parke said. Then there were “absolutely heartbreaking notes from Black colleagues of bias and racism they experienced in the profession.” Last were a not insubstantial number who said it was none of the Academy’s business, and it should “stay in your lane.”

However, in 2017 AAO had begun an outreach programme to encourage more minority participation in ophthalmology, which had only 6% minority representation in a country with a 30% minority population. This is a health as well as a social issue because studies show patients who can identify with their doctors are more likely to go to appointments and adhere to treatment, improving health outcomes, Dr Parke noted. Definitely in ophthalmology and medicine’s lane.

“The borders between eye health and public health, our community and the larger community, and our professional principles and socioeconomic principles are very blurred,” Dr Parke said. Always, actions should be guided by the goals of protecting sight and empowering lives, he advised.

Dr Parke is the outgoing CEO of the American Academy of Ophthalmology. He served for 17 years as president and CEO of the Dean McGee Eye Institute and Edward L Gaylord Professor and Chair of the Department of Ophthalmology at the University of Oklahoma College of Medicine, USA.