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GUEST EDITORIAL
Year : 2020  |  Volume : 68  |  Issue : 7  |  Page : 1239-1242

All India Ophthalmological Society: Stance on COVID-19 pandemic


1 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
2 Centre for Sight Eye Institute, New Delhi, India

Date of Web Publication25-Jun-2020

Correspondence Address:
Dr. Namrata Sharma
Honorary General Secretary, All India Ophthalmological Society, Professor, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1887_20

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How to cite this article:
Sharma N, Sachdev MS. All India Ophthalmological Society: Stance on COVID-19 pandemic. Indian J Ophthalmol 2020;68:1239-42

How to cite this URL:
Sharma N, Sachdev MS. All India Ophthalmological Society: Stance on COVID-19 pandemic. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 1];68:1239-42. Available from: http://www.ijo.in/text.asp?2020/68/7/1239/287539



Globally, as on 8th June 2020, there have been 6,912,751 confirmed cases of COVID-19, including 400,469 deaths, reported to the World Health Organization.[1]

As per the latest data release by the Union Health Ministry on 8th June 2020, coronavirus cases in India continue to surge and has taken the tally to over 2.4 lakh cases in India.[2] Even as the death toll in India has reached 7,200,[2] the Union Health Ministry has said that the mortality rate in COVID-19 cases in the country is 3.06% as against the global rate of 6.65.[3]

Researchers all across the world are working at breakneck speed, both to understand the virus and also to develop potential vaccines, medicines, and other technologies.

Two months ago, when the country moved into lockdown, we were not acquainted with or were not aware of what life is going to be in the COVID-19 era or after the lockdown is over. These are the difficult times for everyone, and we have to stand in solidarity with the medical community to fight with this dreadful disease.

The ophthalmic community is globally facing extraordinarily challenging times due to the COVID-19 pandemic. While the world is asked to stay at home with social distancing recommendations, ophthalmology colleagues and their teams continue to provide ophthalmic care to our patients.

Ophthalmologists and eye health teams work close to their patients as part of the eye examinations and treatment, and they are at exceptionally high risk of being exposed to the virus and contracting COVID-19. Their protection and that of patients is critical due to the rapid spread of coronavirus.

All India ophthalmological society (AIOS) webinars

In the lockdown period to keep members au courant, many educational webinars were organized on a regular basis with very thoughtful and inclusive topic selection.

The first webinar very rightly titled “All You want to know about COVID-19” gave a complete insight about the diseases, its infection and spread along with the safety measures directly from the experts: the pulmonologist and physician from the premier institute which focused on ways to prevent and diagnose the COVID-19 infection, management protocol and steps for protection, in general.

With the uncertainty in the environment it was important that our members directly hear from the experts and seasoned members on how to stay afloat during and after the Corona crisis and the webinar on “Management of Ophthalmic Practice & Finance” was planned. This focused on topics such as precautions to be taken in the outpatient department and operation theatre, COVID-19 related research in ophthalmology, financial prudence, the impact of COVID-19 on ophthalmic practice and how to stay positive and how to rebuild practice beyond COVID-19.

An international webinar on “Fighting CORONA Crisis Globally” gave us an insight on how international experts in various countries are fighting the corona crisis and what are their plans to resume practice in their respective countries. This was especially relevant as all countries are in different stages of Corona crisis. Experts from Japan, USA, Italy, Hong Kong, Singapore, and India joined as speakers.

Telemedicine in Ophthalmology: current platforms, webinar was planned as telemedicine is the “new normal.” This topic focused on the recently changed guidelines from Government of India, as 3 months online training was no longer required, given the situation of COVID-19. Various telemedicine platforms in ophthalmic practice which were in practice were discussed which included telemedicine platforms relevant to solo practice, group practice, corporate sector, and institutes.

With so many apprehensions and questions coming in the mind of all, it was apt to organize the webinar on ”Roadmap to Recovery” with financial and managerial experts from Corporate World and advocate from the Supreme Court. The medico-legal aspects in ophthalmic care were very well addressed by the expert advocate from the Supreme Court and the queries of the members were addressed.

As it is said that “Mens Sana in Corpore Sano,” it is important to focus on the healthy mind of our colleagues, peers, and the young generation in this difficult period. The webinar by Dr. Mickey Mehta “Mindful Insight Neutralizing Duality” focused on the holistic health and was the need of time. All these webinars were live using webcast, Facebook, and Youtube and cumulative views were more than 2 lacs as of now and are available on the AIOS website www.aios.org.

AIOS ophthalmic practice guidelines in the COVID-19 era

Though there was a lot of sporadic information available, the need for extensive, all-inclusive guidelines was primarily felt. To help protect eye health providers and in response to the growing needs of our global eye health community for information, All India Ophthalmological Society took the initiative and drafted the first such guidelines “Ophthalmic Practice Guidelines in the Context of COVID-19 era.” These guidelines are comprehensive and include the combined efforts of more than 225 Experts, in more than 13 various sub-specialties. Each of these guidelines was formulated by the respective sub specialties society from India which included Indian Society of Cornea and Keratorefractive Surgeons (ISCKRS), Cornea Society of India (CSI), Glaucoma Society of India (GSI), Indian Neuro-Ophthalmology Society of India (INOS), Intraocular Implant and Refractive Society India (IIRSI), The International Society of manual small incision cataract surgeons (ISMSICS), Eye Bank Association of India (EBAI), Oculoplastic Association of India (OPAI), Ocular Trauma Society of India (OTSI), Strabismus & Pediatric Ophthalmology Society of India (SPOSI), Vitreo Retina Society of India (VRSI), Uveitis Society of India (USI) and VISION 2020, representatives from National Programme for Control of Blindness and Ministry of Health and Family Welfare, Government of India and more than 20 hours of zoom meetings. These guidelines are a dynamic document which includes A to Z of ophthalmic practice for various surgeries in the COVID-19 times and these will continue to improvise as and when the new information is received.

The guidelines are based on the information issued by various relevant organizations, Indian Council of Medical Research (ICMR), Ministry of Health and Family Welfare, National Programme for Control of Blindness and State and Central Governments, as on the date of release. These guidelines are prepared with a singular mind to inform and guide Ophthalmic Practitioners in the best interests of doctors, patients, healthcare staff, and community in general. Owing to the present context and also the complex nature of the medical profession in terms of unpredictable outcomes, these guidelines are required to be construed as bona fide opinions of experts. Be that as it may, it is necessary to understand and appreciate that these guidelines do not substitute or override applicable statutory and ethical mandates. The guidelines are to be tempered with the regional, local, and individual hospital guidelines and expertise. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient considering all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition.

The guidelines for the functioning of ophthalmology facilities focused on protocols regarding Outpatient Department, dilatation, refraction, disinfection, Pre-admission protocol, housekeeping protocols, and advise to staff to safeguard from COVID-19. The Operation theatre guidelines focused on safety aspects from the surgery point of view. The guidelines provided details regarding the usage of air conditioning as well. For those having Heating Ventilation and Air Conditioning (HVAC) systems in Operation Theatre, the air handling units (AHU) can be functional in-between cases with appropriate temperature and humidity. Air changes and fresh air intake to be maximized as per the HVAC. For those having split air conditioners, non-COVID-19 Operation Theatre can have stand-alone room air conditioners and air needs to be re-circulated within a single occupied zone in the OT complex. The temperature and humidity need to be maintained appropriately and air filters to be cleaned frequently.

Guidelines focused on cataract surgery, refractive surgery, cornea and eye banking, glaucoma practice, uvea practice, vitreo retina practice, oculoplasty and oncology practice, pediatric ophthalmology, squint and neuro-ophthalmology, ocular trauma and community eye health and vision centres covered all the aspects of respective surgery and practice in detail with deep insights on what needs to be changed in the practice in the COVID-19 era and beyond.

All these guidelines are to be published in the Indian Journal of Ophthalmology (IJO). Evolving consensus on managing vitreo-retina and uvea practice in the post–COVID-19 pandemic era [4] and All India Ophthalmological Society -Oculoplastics Association of India Consensus Statement on Preferred Practice in Oculoplasty and lacrimal surgery during the COVID-19 Pandemic [5] are already being published in IJO.

Representation to various government authorities

AIOS sent representation to the Prime Minister's Office, Ministry of Health and Family Welfare, Ministry of Finance, Finance Secretary and Cabinet Secretary to allocate funds as Special aid to keep the Ophthalmic Care afloat in the difficult times. The petition focused on subsidence of salaries of healthcare staff, provision for compensation to medical professionals and healthcare workers for disease during patient care, interest-free loans to healthcare providers, releasing public sector unit payments and third party administrator (TPA) payments at the earliest, moratorium on statutory dues, temporary stoppage on equated monthly instalments (EMI) payments and interest, subsidy on electricity and water bills of medical establishments, waiving off corporation taxes, freezing rental dues and utility payments, immediate rectification and relief in advance tax, allowing input credits for GST and providing relief in intraocular lenses, all accreditations and regulations to be valid till the crisis is over and appeal for financial aid to health care providers.

A representation was submitted to the Medical Council of India seeking clarification of the telemedicine practice guidelines. And a representation was also sent to Insurance Regulatory and Development Authority (IRDA) and Hon'ble Health Minister regarding the clause “Subject to the exclusion of the communicable disease” in the professional Indemnity Policy; following this the IRDA withdrew the clause.

A request was also submitted to NITI Aayog for financial aid to healthcare providers - Eye care hospitals and Ophthalmologists in the wake of COVID-19 pandemic and a positive response was received to look into the suggestion.

A request was sent to Directorate General of Health Services to take up the issue of providing immunity from civil liability to healthcare professionals for any injury or death alleged to have been sustained directly as a result of an act or omission by such professional in providing medical services during the pandemic unless such injury or death was caused by professional gross negligence.

AIOS industry connect

AIOS from the beginning of the COVID-19 pandemic initiated communication with the Industry Partners with the motive to stand together in these difficult times of major economic disruptions. An exigency appeal was sent to all the Industry Partners to support the Ophthalmic community by extension of the CMC/AMC period, an extension of warranty, deferment of the encashment of post-dated cheques, rescheduling off EMIs, not increasing the Annual Maintenance Contracts/Comprehensive Maintenance Contract and cost of bundled products.

Also, to support the Industry, a request letter was sent to all AIOS members and State Societies to restrain on having the Continued Medical Education, meetings, conferences, and other related activities to reduce the financial burden on Industry partners.

A webinar was organized with representatives from companies and AIOS Trade relations committee along with the Governing Council to have transparent and productive communication.

Psychological impact of COVID-19 on ophthalmologists in India

The results of an online survey conducted on ophthalmologists demonstrated that a significantly high number of ophthalmologists were affected psychologically by the COVID-19 crisis and there is a need for personalized mental healthcare from psychologists and psychiatrists, especially for those with moderate/severe depression. This study showed that even the health workers who are not at the forefront of COVID-19 care and at less risk of being affected are suffering mental health consequences due to multiple factors. The national and state ophthalmology societies, health administration, and the government should be cognizant of the need to support the mental health of all the healthcare workers, and not only those in the frontline of the management of COVID-19 infection.[6]

Survey-ophthalmology practice in the times of COVID-19

Over the past several weeks, practitioners have received guidance from numerous sources to guide ophthalmology practice during this time of the pandemic. However, how exactly patients are triaged, what conditions are being seen, and how clinics are operated is still largely up to physician and staff judgment.

AIOS completed a Survey to understand the practice trends of ophthalmology practices during this difficult time. The main aim of the survey is to be a means of sharing productive ideas, standardizing practices, and seeking guidance on potentially unaddressed issues. The survey results will benefit others by providing further guidance on how ophthalmologists can run their practices during COVID-19.

Virtual/hybrid conferences and trade

The COVID-19 pandemic has taught all of us that all conferences need to place top priority on the health and safety of the meeting participants and attendees. The virtual conferences or hybrid model conferences will be the New Normal for us. American Society of Cataract and Refractive Surgery (ASCRS) organized their first virtual online meeting in the month of May 2020. Asia Pacific Academy of Ophthalmology (APAO) has cancelled its conference in the year 2020. The World Ophthalmology Conference (WOC) and Eye Bank Association of America (EBAA) are organizing virtual conferences in 2020.

American Academy of Ophthalmology (AAO) is working on the hybrid model of the conference that will combine a “live” in-person event with a “virtual” online component. New sanitation and cleaning procedures will be implemented, the layout of all session rooms, labs will be planned to increase the physical distancing.

Along with the conference, the trade will also be changed into a virtual exhibition where the exhibitors and participants will meet one another on the web. While some events will be hosted only online, virtual trade shows could also be run in conjunction with real-world or in-person trade shows, creating “hybrid events”.

Online ophthalmic education and training

The online training of the fellows and the residents have been hit during the COVID-19 times. Institutes engaged in fellowship programs are considering extending the period of fellowship for a variable period. AIOS is preparing online courses in various subjects so that these can be availed by the trainees and the postgraduates. Surgical training is the backbone of ophthalmic education and a lot of focus is given in the past on classroom lectures and hands-on training in person. But with the COVID-19 pandemic, this trend is going to change. The silver lining in the pandemic is that the institutions will now be better prepared to integrate the new technology solutions to their academic programs and modalities such as webinars, simulation-based learning, artificial intelligence, etc. will come to the fore.[7]

We are fortunate to have well-structured curricula available both for residency as well as for the subspecialties of ophthalmology. For the surgical training virtual simulators need to be made available at the Institutes and the Government should seriously look into making them available for the ophthalmic students.

Financial impact

Ophthalmic medical care will get more expensive given the protective protocols that hospitals will have to put in place. Costs have increased for all setups such as disinfection, sterilization, infection control measures, staff rotations, quarantine of the team in case of COVID-19 infection and added cost of protective gears such as the PPE kits. The brunt of this financial burden will ultimately be borne by the patient and the service provider. With a large reduction in patient footfall and increasing operating losses, the healthcare sector will need a fiscal stimulus.

Tele-ophthalmology

Telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission of COVID-19 but despite the substantial growth of telemedicine and the evidence of its advantages, in ophthalmology the usage of telemedicine has been limited. In fact, in the ophthalmology, it is more teleconsultation as the eye needs to be thoroughly examined by the ophthalmologists.

Recent patient and provider interest in telemedicine, the relaxation of regulatory restrictions and ongoing social distancing practices compel many ophthalmologists to consider virtualizing services. Artificial Intelligence (AI) -assisted automated screening and diagnosis of the common diseases in ophthalmology may eventually help maximize the doctors' role at the clinics while maintaining the social distancing. AIOS is working on finalizing a panel of Tele-ophthalmology platforms for all its members and in the near future, the teleconsultation in ophthalmology will be a New Normal.

This has been a testing time for the whole ophthalmic fraternity and AIOS is trying all means to help and support everyone to get ready for the times when the “NEW NORMAL” life starts, while also being mindful and sensitive towards challenges each one is facing.

The consequences of this pandemic in the coming few months are unknown, and no one can say with certainty when life is going to return to NORMAL, or a NEW NORMAL is going to transpire, in which new systems and practices will restore our long made habits and practices. The new normal is going to be different, but as it is said that change is the only constant in life, we hope that this change will bring hope and we all will learn to live with this new normal.

We still have a long way to go before this pandemic comes to an end, but with continued hope, balanced approach and togetherness, we will FIGHT CORONA.

 
  References Top

1.
WHO Coronavirus Disease (COVID -19) Dashboard. Available from: https://covid19.who.int/. [Last accessed on 2020 Jun 08].  Back to cited text no. 1
    
2.
COVID-19 India. Available from: https://www.mohfw.gov.in/. [Last accessed on 2020 Jun 08].  Back to cited text no. 2
    
3.
4.
Gupta V, Rajendran A, Narayanan R, Chawla S, Kumar A, Palanivelu MS, et al. Evolving consensus on managing vitreo-retina and uvea practice in the post-COVID-19 pandemic era. Indian J Ophthalmol 2020;68:962-73.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Ali MJ, Hegde R, Nair AG, Bajaj MS, Betharia SM, Bhattacharjee K, et al. All India Ophthalmological Society-Oculoplastics Association of India consensus statement on preferred practices in oculoplasty and lacrimal surgery during the COVID-19 pandemic. Indian J Ophthalmol 2020;68:974-80.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Khanna RC, Honavar SG, Metla AL, Bhattacharya A, Maulik PK. Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India. Indian J Ophthalmol 2020;68:994-8.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Grover AK. COVID-19 crisis and residency education: A moment to seize the opportunity and create a new road map! Indian J Ophthalmol 2020;68:959-60.  Back to cited text no. 7
    

 
  Authors Top


Prof. Namrata Sharma
Prof. Namrata Sharma did her post-graduation from Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. She did her fellowship from Moorfields Eye Hospital in London, UK. She is the Regional Secretary, Asia Pacific Academy of Ophthalmology and Honorary General Secretary of All India Ophthalmological Society. She has two patents to her credit and more than 450 publications in international peer reviewed journals. Her international awards include Senior Achievement Award, International Ophthalmologist Education Award and “Best of Show” awards (6 times) by the American Academy of Ophthalmology. She has 118 book chapters and has authored 11 books. She has been conducting numerous instruction courses at various international conferences. She has contributed to path- breaking research and is the principal investigator in many multicentric international clinical trials.


Prof. (Dr.) Mahipal Singh Sachdev
Prof. (Dr.) Mahipal Singh Sachdev, a Padmashri awardee, is the Founding Chairman and Medical Director of the Centre for Sight Group of Eye Hospitals, a network of 43 specialized eye care centres across the country. He is an illustrious alumnus of and a former faculty at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. He received specialty training in Cornea at the Georgetown University, USA. Dr Sachdev is an ophthalmic entrepreneur with deep academic passion. He was one of the youngest to chair the All India Ophthalmological Society (AIOS) Scientific Committee; he was also the Secretary and President of Delhi Ophthalmological Society, and Secretary and Chairman, Scientific Committee of the Intraocular Implant and Refractive Society of India, and is currently the President of the AIOS, the largest national professional ophthalmological society in the world. As the Managing Editor of IJO, Dr Sachdev takes very keen interest in its vision and mission, and is passionate about empowering the Indian Ophthalmologists through his robust and timely articles in the Journal.




 

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