NLIGHTENMENT CATARACT SURGERY
Amid the Pandemic Safety Precautions Before and During Cataract Surgery
by April Ingram
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or more than six months, most regions around the world have been implementing social distancing measures, and the term “new normal” seems to be something we are settling into. Maintaining a two-meter distance between people and avoiding crowded and congested areas are now the norm. Our hands require a minimum of 20 seconds of cleaning with a 70% alcohol-based solution or with soap and water. Proper use of a mask and other personal protective equipment (PPE) is essential. It seems as though the COVID-19 virus is going to be with us for some time and has already demonstrated its strong potential to re-emerge, even if once effectively contained.
Eye care and pandemic measures Despite the importance of pandemic measures, however, our patients continue to require regular eye care. And the need for cataract surgery has certainly not diminished. In order to meet the need, healthcare systems and surgeons have had to be strategic and thoughtful about how to implement important changes in patient management and surgical practice to address the COVID-19 new normal. The good news is that surgeons — especially ocular surgeons — are, and have always been, masters of infection control. In fact, one of the safest places that someone could be over the next few months would be in an operating theatre. The challenge is getting to that stage.
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Overcoming challenges in patient management Two cataract surgeons from very different parts of the world share their expertise and management strategies from the last few months and how they see cataract surgery moving forward from here. Dr. Keith Yap is an ophthalmologist and surgeon in Kelowna, British Columbia, Canada. He shared that cataract surgeries were stopped by their local health region from the middle of March until mid-June this year. Although surgeons and all medical professionals looked to government and national societies, such as the Canadian Ophthalmological Society (COS), for recommendations and protocols, as Dr. Yap explained, some of the best information came from colleagues. “The COS and provincial health authority did provide some guidance for ‘minimum standards’, which were fairly standard things. But one place that myself and fellow British Columbia ophthalmologists found really helpful was the BC ophthalmologists chat groups, where we could discuss what was happening, and bounce ideas off one another about how to best manage things,” shared Dr. Yap.
are masked, and temperatures are checked when they enter the hospital. Their drivers or caregivers are asked to wait outside until we call them back after the surgery is complete,” explained Dr. Yap. “The waiting room has only one-third of the chairs, and cleaning of the area is done more frequently. We are all gowned and gloved and the patient enters the OR with their surgical mask. Once we are ready to proceed, I remove the patient’s mask and replace it with the plastic drape, because I think the mask and the drape might be claustrophobic for the patient. Once the surgery is done, I remove the drape and replace the patient’s mask,” concluded Dr. Yap.
“Symptomatic persons will not be allowed entry, and those who were once COVID-19 positive must be recovered and certified negative.” – Dr. Boateng Wiafe
Measures to control the airborne transmission of the virus Dr. Boateng Wiafe, an ophthalmologist and surgeon at Watborg Eye Services in Awutu Bereku, Ghana, agrees that the key to managing COVID-19 infections is to take serious measures to control the airborne transmission of the virus.
When cataract surgeries began again in June, very little has changed within the operating room, which has always been under strict protocols directed by the Kelowna General Hospital infection control committee. But those changes were more about how patient flow was managed.
Similar to the practices in Canada, temperature and symptom checks are performed before the patient may enter the hospital. “Symptomatic persons will not be allowed entry, and those who were once COVID-19 positive must be recovered and certified negative,” Dr. Wiafe said. “We need to be vigilant because every person entering the hospital premises is a potential asymptomatic COVID-19 carrier.”
“In general, cataract surgery has a low aerosolization risk, so we perform the procedure in much the same way. The big differences are that patients
Patients in Ghana also wear masks inside the operating room, and they do one more additional step. “Just before coming into the operating theatre,
| Sept/Oct 2020
