Implementing best practices for cataract surgery during COVID-19 times

According to estimates, cataracts cause 51 per cent of world blindness and are the second leading cause of preventable blindness globally. However the current COVID‑19 pandemic has resulted in a pile up of elective cataract procedures due to fears of cross infections.

After consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership, the Government of India (GoI) has given clearance for functioning of eye care facilities, spelling out the precautions and best practices to be followed for elective cataract screening and surgery during Covid-19 times

Dr Jagadesh Reddy, Head of Cataract and Refractive Service, L V Prasad Eye Institute, Hyderabad tells Sanjiv Das how his institute is implementing best practices for elective cataract screening and surgery during Covid-19 times

 What was the effect of COVID-19 related lockdown on ophthalmic practice especially with regards to cataract surgery?

Cataract is one of the leading causes of blindness that can be prevented. There is a significant backlog of surgeries for us to eradicate the blindness due to cataract. In the current scenario this backlog has piled up and would take several years for us to clear all these cases.

If you look at the per cent decrease in the performance of cataract surgeries in comparison to same months in 2019, there has been some improvement. In April 2020, the decrease was 99.55 per cent over April 2019. In May 2020, it improved to 85.6 per cent decrease over May 2019 and in June, it further improved to a 40.6 per cent decrease over June 2019

What cataract surgery guidelines are being followed by LVPEI during COVID-19 pandemic?

The most important factor preventing healthcare workers from starting routine work is the risk of cross infection. What measures have the hospital taken in this regard? Several measures are taken at different points of time to decrease cross infection:

While booking appointment: the necessary history of well-being of the patient and family members is emphasised

Hospital premises: Triage centre screens every patient for any symptoms of COVID-19 with appropriate history and temperature measurement. If any patient has any symptoms, they will be examined in an isolation room

Clinic:

       All health care workers use necessary personal protective equipment at all time points

       Digital payment methods and self-check-in kiosks have been made available in the clinic to minimise the physical contact with any object or personnel

       Staggered appointments to maintain social distancing in the waiting halls

       All elderly patients (80 years and above) will be examined on a high priority to minimise their stay in the hospital

       Modification in the examination process to minimise patient movement between rooms and the need for any test that requires a contact with the patient. Complete preference is given to non-contact tests

       Planning surgery: In case a patient requires a cataract surgery every attempt is made to complete the necessary planning on the same day. In case the patient needs additional systemic workup, a provision has been made to get the same with his/her physician close home and share the documents with us

Surgery:

       Staggered surgery appointments to minimise waiting in the hospital

       Modifications in the steps of the surgery that minimise the duration of the procedure or generation of aerosols

       The use of disposable material wherever applicable

       Cleaning the operating room after every case

       Necessary time gap of 20-30 min between each procedure

What role did telemedicine play to reach patients who underwent cataract surgery?

Telemedicine has helped us a lot in decreasing the need for physical consult thus avoiding the risk of cross infection for patient and the health care professionals. Telemedicine has also helped to identify patients who need physical consult for evaluation of cataract.  After surgery the number of physical visits to the clinic is restricted to only one visit. The other consultations are done through telemedicine.

During the lockdown how many cataract surgeries were conducted by your institute?

On an average we will be performing approximately 150 cataract procedures daily across the network. Patients in the rural centers have adopted the “new normal” quickly and have been getting surgeries on a large scale

What will be your post COVID-19 strategies for cataract patients?

Based on ICMR guidelines if there is a development of herd immunity or development of vaccine for COVID-19 we can slowly revert to what we were practicing before. This would be in a phased manner. At present we are working with the “new normal” guidelines.

Could you share the experience of a patient who was treated during the COVID-19 lockdown.

P Babu Rao, aged 58 years, from Hyderabad, had first undergone cataract surgery in his left eye in 2016 at LVPEI. Confident of the quality of services provided at LVPEI, he had no apprehensions regarding his safety. For the first follow-up he was required to come for a visit, but post that he has been receiving follow-up care through teleconsultation.

As he says, “I had a cataract in my right eye and wanted to get it operated in March. But because of the lockdown, I was unable to do so. As soon as the lockdown was relaxed in June, I got the surgery done. All necessary safety precautions and protocols were followed. I was confident that I am in safe hands.”