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   Table of Contents      
ORIGINAL ARTICLE
Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 725-730

Effect of COVID-19 related lockdown on ophthalmic practice and patient care in India: Results of a survey


1 Aditya Jyot Eye Hospital, Wadala; Advanced Eye Hospital and Institute, A Unit of Agarwal's Eye Hospital; Aayush Eye Clinic, A Unit of Agarwal's Eye Hospital, Chembur, Mumbai, Maharashtra, India
2 Foresight International, Hyderabad, Telangana, India
3 Aditya Jyot Eye Hospital, Wadala, Mumbai, India

Date of Submission02-Apr-2020
Date of Acceptance05-Apr-2020
Date of Web Publication20-Apr-2020

Correspondence Address:
Dr. Akshay Gopinathan Nair
Aditya Jyot Eye Hospital, Wadala, Mumbai - 400 031, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_797_20

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  Abstract 


Purpose: In early 2020, the World Health Organization declared the outbreak of the disease COVID-19, caused by a new variant of coronavirus 2019-nCoV as a global pandemic. The government of India ordered a nationwide lockdown for 21 days, limiting movement of people as a preventive measure. This survey was designed and conducted during the lockdown period to assess its effect on ophthalmic practice and patient care in India. Methods: An online survey was sent across to practicing Indian ophthalmologists across through various social media platforms. All valid responses were tabulated and analyzed. Results: A total of 1260 ophthalmologists responded to the survey. Most of the respondents (775/1260; 61.5%) were in private practice and 14.8% (187/1260) were affiliated to ophthalmic institutes. At the time of taking the survey, 72.5% of the respondents (913/1260) were not seeing any patients due to the lockdown. Of those who were still examining patients, 82.9% (287/347) were only seeing emergency cases, based on their own clinical judgement. The proportion of ophthalmologists in ophthalmic institutes, government and municipal hospitals (126/253;49.8%) who were still seeing patients was significantly higher (P < 0.0001) than those in private practice (174/775;22.4%). Apart from emergencies such as trauma, retinal detachment, and endophthalmitis (81.8%), other surgeries that were still being performed included intravitreal injections (9.1%) and cataract surgeries (5.9%). Approximately, 77.5% (976/1260) of the respondents had begun telephonic/e-mail/video consultations or consultations over social media applications since the lockdown began. In addition, 59.1% (745/1260) felt that ophthalmologists were potentially at a higher risk of contracting COVID-19 compared to other specialties while examining patients. When asked about the resumption of practice upon easing off of the restrictions, 57.8% (728/1260) of the respondents said they were unsure of when to resume elective surgeries; furthermore, 62.8% (791/1260) were unsure about the preferred screening strategy or precautionary approach prior to resuming surgeries and were awaiting guidelines. Conclusion: Our survey shows that majority of ophthalmologists in India were not seeing patients during the COVID-19 lockdown, with near-total cessation of elective surgeries. Emergency services were still being attended to by 27.5% of ophthalmologists who responded. A large proportions of ophthalmologists had switched over to telephonic advice or other forms of telemedicine to assist patients. Most of the responding ophthalmologists were unclear about when and how to resume surgeries upon easing off of the COVID-19 related restrictions. Regulatory bodies should take note of this and issue appropriate guidelines regarding the same.

Keywords: 2019-nCoV, cataract, corona, coronavirus, eye, lockdown, ophthalmology, SARS, tears


How to cite this article:
Nair AG, Gandhi RA, Natarajan S. Effect of COVID-19 related lockdown on ophthalmic practice and patient care in India: Results of a survey. Indian J Ophthalmol 2020;68:725-30

How to cite this URL:
Nair AG, Gandhi RA, Natarajan S. Effect of COVID-19 related lockdown on ophthalmic practice and patient care in India: Results of a survey. Indian J Ophthalmol [serial online] 2020 [cited 2022 Aug 10];68:725-30. Available from: https://www.ijo.in/text.asp?2020/68/5/725/282898



In late 2019, a cluster of cases of pneumonia of unknown cause was seen in Wuhan, a large city in China.[1] Subsequently, in early 2020, through genomic sequencing, it was found that these cases were caused by a novel virus, which was called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2); also known as 2019 novel Coronavirus (2019-nCoV).[2] India reported the first case of this Coronavirus disease (COVID-19) on January 30, 2020, in the state of Kerala in southern India, where a student with a history of travel to Wuhan presented with respiratory symptoms. This was followed by two more similar cases on consecutive days.[3] The World Health Organization since then has declared the outbreak to be a global pandemic.[4] As of April 1st, 2020, the total number of confirmed COVID-19 cases, globally has exceeded 9,00,000 and the number of cases in India has crossed 1,700.[5] The global pandemic has led to many governments across the globe to take swift and protective measures. It started in China, when cities were placed under complete lockdown, travel bans were put in place and schools and universities were indefinitely closed.[6] The reason for such drastic measures is that in a large proportion of cases, COVID-19 manifests only as a flu-like illness with fever, cough, sore throat, fatigue, dyspnea, occasional diarrhea, and vomiting, but in the select group of patients such as the elderlies and immunocompromised individuals, the condition deteriorates to acute respiratory distress syndrome (ARDS), septic shock, and multi-organ failure resulting in mortality. The danger is amplified due to the lack of a vaccine and effective therapeutic agents against this novel virus.[7]

The World Health Organization had notified that during previous such coronavirus outbreaks like SARS, human-to-human transmission occurred primarily through droplets, contacts, and fomites. It was suggested that the mode of transmission of COVID-19 could be similar.[8] Across the globe, healthcare workers continue to be at high risk for contracting COVID-19 in the course of their clinical duties toward affected patients. One of them was Dr. Li Wenliang, an ophthalmologist at Wuhan Central Hospital who had contracted COVID-19 from an asymptomatic glaucoma patient and succumbed to the disease later.[3]

Given the large population of over 1.3 billion, the government of India declared a total lockdown across the country as a part of its efforts to control the disease spread. At the time of the announcement, India had 519 confirmed cases and 10 reported deaths due to COVID-19. The restrictions came into force at midnight local time on 24th March 2020 and would be enforced for 21 days.[9] As a result of this lockdown, all regular out-patient departments across hospitals and clinics in India were to be shut and it was advised that all elective surgeries be deferred, but emergency healthcare services should continue to function. As a result of this step, ophthalmologists across the country temporarily ceased clinical services at their respective practice locations. With this background, this study was conceived, and a survey was circulated to assess the impact of the COVID-19 related lockdown on ophthalmic practice and patient care in India. The survey also assesses the perception among ophthalmologists regarding the risks, screening protocols, and prevention strategies related to clinical examination and surgeries after the resumption of their practices.


  Methods Top


An online survey (hosted by www.surveymonkey.com) was circulated among Indian ophthalmologists on the 5th day after lockdown had been enforced. The invitation to participate was circulated through multiple groups on social media, namely, Facebook, WhatsApp, and Telegram. The survey, which consisted of nine questions [Supplementary [Table 1][Additional file 1], was open for a period of 48 hours. It was mandatory to answer all questions and the survey was anonymized and did not contain any identifying information. Association between categorical variables was assessed using Fisher exact test or Chi-squared test. We considered a P < 0.05 as statistically significant. All statistical analysis was performed with GraphPad Prism 6 (GraphPad Inc, La Jolla, CA).


  Results Top


A total of 1260 responses were received at by midnight, 31st March 2020. The respondents were asked to specify the nature of their practice. In all, 61.5% (775/1260) were private practitioners with their own clinics; 14.8% (187/1260) were affiliated to ophthalmic institutes; 9.4% (118/1260) of the respondents were working in corporate/multi-specialty hospitals; 5.2% (66/1260) were working in government/municipal hospitals; and 2.2% (28/1260) were freelancing surgeons. Detailed analysis of this data showed that a significantly higher proportion of ophthalmologists affiliated to ophthalmic institutes, government and municipal hospitals (126/253;49.8%) were currently seeing patients as compared to those in private practice (174/775;22.4%); (P < 0.0001).

The respondents were asked if they were still examining/operating patients, and an overwhelming majority-72.5% (913/1260) indicated that they had completely stopped all clinical work during the lockdown [Figure 1]. The remaining 27.5% (347/1260), who indicated that they were still seeing and operating patients, were asked to specify the type of cases that they were currently seeing. While trauma (51.9%) was the most common type of case being examined, most respondents indicated that any case that would be classified as an emergency (82.9%) were also seen by them. Furthermore, 13.5% (47/347) specified that they were seeing all patients who came to their clinics with no form of triage/screening being performed.
Figure 1: Chart showing the type of cases currently being seen by ophthalmologists who are attending to patients during the lockdown period in India

Click here to view


Regarding surgical procedures, 81.8% (284/347) indicated that they were operating only emergency cases including trauma, retinal detachments, and endophthalmitis. Of the other procedures, 9.1% (32/347) were administering intravitreal injections and 5.7% (20/347) were performing cataract surgery. It was also noted that 4.9% (17/347) of the ophthalmologists were involved in other procedures like tumor/retinoblastoma related care, whereas 12.1% (42/347) were only examining patients presenting with emergencies, but not operating any.

The respondents were asked if they had explored and initiated other avenues of attending to their patients' needs such as telemedicine. Telephonic consultations (54.9%) were the most popular mode of reaching out to patients, followed by email and social media applications like WhatsApp and Telegram (48%). Video-calls for consultation were being used by 9.9% of the ophthalmologists who took the survey. In all, 77.5% (976/1260) of the ophthalmologists had begun utilizing some form of telemedicine since the lockdown began; 12.9% (163/1260) were not currently treating patients remotely but had plans to do so [Figure 2]. In contrast, 9.6% (121/1260) of the clinicians had no plans to start telephonic/electronic consultations. Of those who were currently involved in some form of telemedicine, 90.7% (886/976) were not asking any professional fees from patients; 5.8% (57/976) were charging the same professional fees as they would for an in-person consultation and the professional fees for tele-consultation were less than that for an in-person consultation for 2.9% (28/976) of the ophthalmologists. A small minority 2.9% (5/976) were charging higher than usual fees.
Figure 2: Graph showing the responses of the ophthalmologists when asked about tele-medicine

Click here to view


Ophthalmologists were asked about their perceptions of the risk they face while examining patients, given the scenario of the global COVID-19 pandemic: 59.1% (745/1260) felt that ophthalmologists were at a higher risk of contracting COVID-19 compared to other specialties when it comes to examining patients.

The last part of the survey focused on strategies upon resumption of regular clinical duties after the lockdown period. When asked what their plan regarding elective surgeries would be, upon easing off of the COVID-19 related restrictions, 11.8% (148/1120) said that they would immediately resume elective surgeries as before and 30.4% (383/1260) expressed that they would wait for at least one week before resuming elective surgeries. However, 57.8% (729/1260) were not sure about when to start elective surgeries after the resumption of clinical duties. The respondents were also asked about what their preferred prevention strategy would be, regarding pre-operative screening: majority of the clinicians (62.8%; 792/1260) were unsure of what should be done and were awaiting guidelines; 16.6% (135/1260) indicated that they would prefer to use additional personal protection equipment (PPE) for surgeries; 9.9% (124/1260) indicated that they would want to perform testing for COVID-19, pre-operatively prior to any elective surgery; 10.7% (135/1260) said they would include pre-operative screening for COVID-19 as well as use PPE for all surgeries.


  Discussion Top


Our survey showed that the majority of the practicing ophthalmologists in India were in total lockdown. While the clinicians themselves may be available, the unavailability of managerial, administrative, nursing and other support staff may pose logistical and operational challenges to running a health care facility in times of a pandemic. It was noted that most of the ophthalmologists working in large institutes and government hospitals (126/253;49.8%) were still seeing and operating cases. This is understandable since large hospitals tend to be better equipped in terms of staff, protective equipment, medicines, and in-patient facilities for isolation. Majority of the stand-alone private practitioners (601/775; 77.5%) had closed their practices and were not actively involved in direct patient care.

While emergencies such as trauma and other conditions that qualified for emergent care, based on the judgement of the clinician, remained the most common procedures still being performed, it was interesting to note that at the time of responding to the survey, 9.1% (32/347) of those who were still operating, continued to administer intravitreal injections and 5.7% (20/347) were still performing cataract surgery. There are rare circumstances where a cataract surgery may be classified as an emergency, such as phacolytic glaucoma, subluxated/traumatic cataract, etc., However, the survey was not designed to capture those specific details. Surprisingly, one respondent indicated that he/she was performing refractive surgeries at the time of responding to the survey.

Given the close physical contact nature of their work and the previously discussed modes of transmission of the virus, it is clear that ophthalmologists are one of the more at-risk medical specialists for COVID-19 transmission. The results of our survey indicate that Indian ophthalmologists also perceive themselves to be at a higher risk of contracting COVID-19 as compared to other specialties [Figure 3]. An eye clinic is a high-risk environment for both: the examining doctor as well as the patient and it is important for the ophthalmologist to know why. The knowledge that we have on the ophthalmic implications of the SARS-CoV-2 virus is limited and constantly evolving. Lu et al., in February 2020, reported that ocular surfaces may be a potential target for SARS-CoV-2 invasion.[10] However, some authors do not fully support this. This is primarily because, while some COVID-19 patients do have conjunctivitis, not all of them test positive for SARS-CoV-2 nucleic acid in conjunctival sac swabs. Conversely, there were some patients, who did not have conjunctivitis but tested positive for the SARS-CoV-2 nucleic acid in their conjunctiva sac swabs.[11] It was also speculated that the virus enters the tears through droplets, which may pass through the nasolacrimal ducts and then into the respiratory tract.[11] Xia et al. in their study to investigate the presence of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection enrolled a total of 30 patients in their study. They reported that only two samples of tear and conjunctival secretions that were obtained from one patient with conjunctivitis yielded positive reverse transcription polymerase chain reaction (RT-PCR) results, but the isolation of the virus was unsuccessful. In all, 58 samples from other patients were negative.[2] Soon after this study was published, Jun et al. put forth their paper, where 64 tear samples were collected from a total of 17 COVID-19 patients between the third and twentieth days following the initial symptoms. They found that neither viral culture nor RT-PCR detected the virus, suggesting a low risk of ocular transmission.[12] A more recent study by Wu and colleagues reported that from 38 patients that were included in the study, 28 patients (73.7%) had positive findings for COVID-19 on RT-PCR from nasopharyngeal swabs, and of these, 2 patients (5.2%) yielded positive findings for SARS-CoV-2 in their conjunctival as well as nasopharyngeal specimens. They reported that one-third of patients with COVID-19 included in their study had ocular abnormalities such as conjunctival hyperemia, chemosis, and epiphora which frequently occurred in patients with more severe COVID-19. The authors concluded that although there is a low prevalence of SARS-CoV-2 in tears, it is possible to transmit via the eyes.[13] It is clear that as time goes by, and more clinicians see more COVID-19 cases; the exact mechanism and the magnitude of spread of the disease through tears will be clearer.
Figure 3: Graph showing the responding ophthalmologists' perceptions of the risk they face while examining patients, given the scenario of the global COVID-19 pandemic

Click here to view


It has been postulated from genomic and structural analyses that the SARS-CoV-2 has a similar receptor-binding motif as SARS-CoV, which allows it to infect host cells via the angiotensin-converting-enzyme-2 (ACE2).[14] The virus uses this as a cell entry receptor to invade respiratory and lung epithelium through the spike (S) protein.[15] ACE2 is mainly expressed in posterior tissues of the eye, namely, the retina and the retinal pigment epithelium.[16],[17] While ACE2 has been found in the aqueous humour, the expression of ACE2 in more anterior tissues such as human conjunctival and corneal epithelium has yet to be established.[16],[18] Hence, the hypothesis of SARS-CoV-2 ocular infection through ACE2 must be investigated.

While elective surgeries such as cataract and refractive surgeries can be rescheduled and planned at a later date, other patients such as trauma, postoperative patients, patients with sudden vision loss and infections need to be examined and treated on an urgent basis. It was noted that in our survey, 77.5% of the ophthalmologists who took the survey had begun engaging in some form of telemedicine since the lockdown began and a further 12.9% of the population were planning on starting soon. In India, telemedicine practice guidelines were issued recently to enable medical practitioners to provide healthcare using telemedicine.[19] It is important to reach out to existing patients or those with existing appointments to inform about the change in their appointments. In Hong Kong, during the COVID-19 outbreak, eye hospitals utilized short message service (SMS) to send information to patients via their electronic mobile devices, at least one week in advance before their scheduled appointments, providing them with an enquiry phone number so they could call to postpone their appointments.[8] Traditionally, tele-ophthalmology has been employed mainly for patients in under-served rural areas in need of specialty care. However, at times of public health emergencies like a pandemic, a simple phone call or a video-call between the ophthalmologist and the patient serves as a telemedicine tool that can help in deciding if the case requires emergent medical care or not.[20] A "virtual triage," either using smartphones or webcam-enabled computers allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.[21] Situations such as a global pandemic pose unique challenges to the healthcare delivery system. Although tele-medicine will not solve them all, it remains well suited for scenarios such as the one we face today, where infrastructure remains intact and clinicians are available to see patients.[21]

In an effort to reduce the risk of the SARS-CoV-2 virus transmission from human to human and the rate of new case development, many ophthalmic societies, such as the American Academy of Ophthalmology (AAO) as well as the All India Ophthalmological Society (AIOS) have issued recommendations regarding cessation of routine clinical and surgical duties.[3],[22] The AIOS has recommended postponement of all routine consultations and elective surgeries by four weeks. It was also recommended that all ophthalmologists provide urgent or emergent care, and triage and reschedule all elective OPD visits and procedures. This has been found to be very useful in ensuring that emergent patient care is not compromised and the potential for disease spread is kept to a minimum during the pandemic and lockdown period.

The most crucial bit of information that the survey highlighted was the lack of clarity among clinicians about how to proceed after the resumption of routine services, once the lockdown period is over [Figure 4] and [Figure 5]. In our survey, many respondents indicated that they would prefer to use additional personal protection equipment (PPE) for surgeries or perform testing for COVID-19 pre-operatively prior to any elective surgery or even both. Unless there is unequivocal evidence that proves the utility of these additional measures in all patients, they would add to the cost of patient care. There is also uncertainty over the possibility of an extended lockdown, but that notwithstanding, it is important that ophthalmic societies consult with experts, study the available literature and issue clear guidelines about the timing for resumption of routine elective surgery and the necessary steps to be taken by all ophthalmic surgeons to minimize the chances of COVID-19 contraction and spread. Complicating this issue further is the presence of asymptomatic or pre-symptomatic COVID-19 patients who exhibit no clinical signs of the disease but test positive for COVID-19 and can potentially infect others.[23]
Figure 4: The ophthalmologists' responses when asked about timing for re-starting elective surgeries upon lifting up of the lockdown

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Figure 5: Graphical representation of the responses when asked about surgical strategies upon resumption of elective surgeries after the lockdown

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The lockdown, which was a first in the country, brought with it, many uncertainties; not just on the personal front but also on the professional front for most medical practitioners. In this survey, a total of 1260 responses were recorded: even though this is a very large number, we understand that this does not represent the complete Indian ophthalmic fraternity. Given the fast-evolving scenario, it was not feasible to have a validated survey; also, the authors felt it necessary to keep the survey open only for a short period of time during the lockdown itself. Age and geographic information of the respondents could have provided more insights such as areas where emergency eye care was unavailable, among other things.


  Conclusion Top


COVID-19 pandemic will change the way we practice forever. Changes in the clinic management policy: scheduling appointments, active screening, patient healthcare declarations, expedited consults for sick patients, and other waiting room policies, may become permanent. Staff protection and environmental precautions to prevent droplet and fomite transmission are also likely changes.[24] It is possible that in the days to come, evidence will emerge which may change the prevention and treatment strategies for COVID-19. The disease and the restrictions in place for limiting its spread are challenges for the Indian ophthalmic community, and the global ophthalmic fraternity at large. But for the ophthalmology community to get back to serving society at large in an optimal and secure way, clear guidelines need to be evolved by the regulatory bodies to help resume patient care without compromising on safety; both––their patients' as well as their own.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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11 COVID-19 Pandemic and the Operation of a Tertiary Hospital in Tianjin—The Impact of Internet Healthcare on Hospital Business Indicators
Jia Chen, Liu Jie, Xiao Su, Xin Zhang, Dandan Guo, Jiajing Wang, Meili Deng, Mingrui Cui, Meijian Gao, Hong Zhang, Yijun Song
Frontiers in Public Health. 2022; 10
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12 Approach of an Academic Ophthalmology Department to Recovery During the Coronavirus Pandemic
Alexandra C Brodin, Madhura A Tamhankar, Gideon Whitehead, David MacKay, Benjamin J Kim, Joan M O'Brien
Clinical Ophthalmology. 2022; Volume 16: 695
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13 Impact of the Coronavirus Disease 2019 Pandemic on the Ophthalmology Department
Ha-Eun Sim, Kyeong-Do Jeong, Je-Hyung Hwang
Journal of Clinical Medicine. 2022; 11(6): 1722
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14 EFFECT OF COVID-19 PANDEMIC ON OPHTHALMOLOGY RESIDENTS IN NORTH INDIA
Riya Chopra, Gaurang Sehgal, Diksha Diksha, Prempal Kaur
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH. 2022; : 66
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15 Patients with Neurological Illnesses and Their Experience During the Lockdown: A Teleinterview-based Study
Pranjal Gupta, Biswamohan Misra, Pachipala Sudheer, Rohit Bhatia, MamtaB Singh, MV P. Srivastava, Manjari Tripathi, AchalK Srivastava, Kameshwar Prasad, Deepti Vibha, VY Vishnu, AwadhK Pandit, RajeshK Singh, Anu Gupta, A Elavarasi, Animesh Das, MR Divya, Bhargavi Ramanujam, Ayush Agarwal
Annals of Indian Academy of Neurology. 2022; 25(1): 76
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16 Comparison of eyecare utilization at two service delivery levels during the COVID-19 pandemic as a measure of their impact: A multicentric retrospective analysis across four North Indian high-volume eyecare organizations
Ishaana Sood, Shalinder Sabherwal, Subeesh Kuyyadiyil, Ashi Khurana, Anshu Thakur, Lokesh Chauhan, Elesh Jain, Madhu Bhadauria, Atanu Majumdar
Indian Journal of Ophthalmology. 2022; 70(6): 2146
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17 Evaluation of a revised care plan for babies with retinopathy of prematurity during SARS-CoV-2 pandemic in India
DineshNarayan Suhan, Avinash Singh, Utpal Bhusal, Bhavik Panchal, Komal Agarwal, Sameera Nayak, Sameer Nayak, Sushma Jayanna, Taraprasad Das, Subhadra Jalali, VishalSanjay Jadhav, TapasRanjan Padhi
Indian Journal of Ophthalmology. 2022; 70(7): 2480
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18 Feasibility study for measuring patients' visual acuity at home by their caregivers
NavyaDeepthi Davara, Raghavachary Chintoju, Neelima Manchikanti, Chodup Thinley, PravinKrishna Vaddavalli, PadmajaKumari Rani, PremNandhini Satgunam
Indian Journal of Ophthalmology. 2022; 70(6): 2125
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19 The impact of the COVID-19 pandemic on eye care services and training in Nigeria
Olusola Olawoye, HenriettaIfechukwude Monye, FolahanA Ibukun, OluwatoyinH Onakpoya, OlabisiO Yeye-Agba, ChigozieIfeoma Echieh, BomaR Obuoforibo, ChikaNjideka Bassey, MaryamIdris Abdullahi, Diamond Tonye-Obene, FolasadeBolanle Akinsola
Nigerian Journal of Medicine. 2022; 31(3): 280
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20 Analysis of ophthalmic emergency visits during COVID-19 Lockdown in a tertiary eye care center in South India
SohamSubodhchandra Pal, MdShahid Alam, SarangMurlidharrao Giratkar, Bipasha Mukherjee
TNOA Journal of Ophthalmic Science and Research. 2022; 60(1): 2
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21 Effect of Lockdown and Unlock Following COVID-19 on the Presentation of Patients With Endophthalmitis at a Tertiary Eye Center Over One Year
Anthony Vipin Das, Vivek Pravin Dave
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22 Patient Experience Survey in a Corneal Service Conducted by Remote Consultation
Navid Hakim, Philippa Longmore, Victor H Hu
Clinical Ophthalmology. 2021; Volume 15: 4747
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23 The perceived impact of webinars during the COVID.19 pandemic: A survey of ophthalmology trainees from India
Deepak Mishra, AkshayGopinathan Nair, Lalit Verma, AshokKumar Grover, Satanshu Mathur, Tanmay Srivastav
Oman Journal of Ophthalmology. 2021; 14(2): 78
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24 Expanding the scope of tele-ophthalmology from vision centers to home
Lokeshwari Aruljyothi, Alap Bavishi, ManoharBabu Balasundaram, Anuja Janakiraman, Kritika Shekar, Harshita Atmakur
Indian Journal of Ophthalmology. 2021; 69(2): 442
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25 Perception among ophthalmologists about webinars as a method of continued medical education during COVID-19 pandemic
Rimpi Rana, Devesh Kumawat, Pranita Sahay, Neeraj Gour, Siddharth Patel, Ramanuj Samanta, Anupam Singh, Sanjeev Mittal
Indian Journal of Ophthalmology. 2021; 69(4): 951
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26 The impact of COVID-19 “Unlock-I” on L V Prasad Eye Institute Network in Southern India
VarshaM Rathi, RajeevPappuru Reddy, Merle Fernandes, Suryasnata Rath, Sameera Nayak, JojiPrasad Satya Vemuri, NiranjanKumar Yanamala, Rajashekar Varda, Srinivas Marmamula, AnthonyVipin Das, RohitC Khanna
Indian Journal of Ophthalmology. 2021; 69(3): 695
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27 Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute
Deepanshu Agrawal, Swapnil Parchand, Deepshikha Agrawal, Samrat Chatterjee, Anil Gangwe, Mihir Mishra, Anupam Sahu
Indian Journal of Ophthalmology. 2021; 69(3): 709
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28 A questionnaire-based assessment of Safe Eye Examination (SEE) technique
Divyansh Mishra, MaheshP Shanmugam, EVivek Chaitanya, Kaushik Murali, Rajesh Ramanjulu, Mayur Kulkarni, Sukanya Nair
Indian Journal of Ophthalmology. 2021; 69(9): 2321
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29 Impact of COVID-19 on Indian optometrists: A student, educator, and practitioner's perspective
Shivalika Sehgal, Lakshmi Shinde, Gopinath Madheswaran, Paula Mukherjee, Pavan Verkicharla, Soumya Easwaran, Kalika Bandamwar
Indian Journal of Ophthalmology. 2021; 69(4): 958
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30 Post-lockdown challenges for ophthalmologists during COVID-19 pandemic in India: A survey-based analysis
Madhav Goel, Sonu Goel, MahipalSingh Sachdev, Namrata Sharma, Deepak Mishra, Gautam Yadav, Nabanita Barua, Sulakshna Aggarwal
Indian Journal of Ophthalmology. 2021; 69(4): 946
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31 Intricate scientometric analysis and citation trend of COVID-19-related publications in Indian Journal of Ophthalmology during COVID-19 pandemic
Kirandeep Kaur, Bharat Gurnani
Indian Journal of Ophthalmology. 2021; 69(8): 2202
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32 Changing patterns of posterior segment trauma during the COVID-19 pandemic: A regional analysis from the Bodhya Eye Consortium
Swapnil Parchand, Pratik Shenoy, Alankrita Muralidhar, Gaurav Kohli, Anil Gangwe, Deepanshu Agrawal, Abhishek Varshney, Ruchi Mittal, Indranil Saha, Aishwarya Madharia, Shalini Singh, Alok Sen, Hemant Trehan, Manisha Agarwal
Indian Journal of Ophthalmology. 2021; 69(10): 2828
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33 Two brutal waves of COVID-19: Where does ophthalmology residency training stand?
Anujeet Paul, Dipika Sainath, Swathi Nagarajan, AR Rajalakshmi
Indian Journal of Ophthalmology. 2021; 69(9): 2547
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34 Prevalence and effectiveness of innovative techniques in ophthalmic surgical training during COVID-19 pandemic in India
Jaya Kaushik, YV K Chaitanya, Ashok Kumar, Pushpendra Jakhar, Rakesh Shetty, Aanchal Singhal, JK S Parihar, Ankita Singh
Indian Journal of Ophthalmology. 2021; 69(12): 3704
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35 Tele-rehabilitation for visually challenged students during COVID-19 pandemic: Lesson learned
SurajSingh Senjam, Souvik Manna, Praveen Vashist, Vivek Gupta, Sara Varughese, Radhika Tandon
Indian Journal of Ophthalmology. 2021; 69(3): 722
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36 Public willingness for accessing teleconsultation services for eye care
Shivalika Sehgal, Bidisha Bhattacharya, Sourav Datta, PremNandhini Satgunam
Indian Journal of Ophthalmology. 2021; 69(12): 3772
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37 Continuing ophthalmology practice in crisis - Lessons from COVID-19 pandemic
Atul Kumar, Vineet Batwani, Nawazish Shaikh
Indian Journal of Ophthalmology. 2021; 69(4): 995
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38 Profile of patients receiving intravitreal anti-vascular endothelial growth factor injections during COVID-19-related lockdown
ManaviD Sindal, Kanika Chhabra, Vaibhav Khanna
Indian Journal of Ophthalmology. 2021; 69(3): 730
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39 Propensity of aerosol and droplet creation during oculoplastic procedures: A risk assessment with high-speed imaging amidst COVID-19 pandemic
Roshmi Gupta, Khushboo Pandey, Rwituja Thomas, Saptarshi Basu, Bhujang Shetty, Rohit Shetty, AbhijitSinha Roy
Indian Journal of Ophthalmology. 2021; 69(3): 734
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40 Impact of teleophthalmology during COVID-19 lockdown in a tertiary care center in South India
Meenakshi Ravindran, Ashwin Segi, Syed Mohideen, Fathima Allapitchai, Ramakrishna Rengappa
Indian Journal of Ophthalmology. 2021; 69(3): 714
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41 COVID-19 pandemic and lockdown: Changing trends in Ophthalmology for in-patient and emergency services
Obaidur Rehman, Parul Ichhpujani, Shifali Nayyar, Suresh Kumar
Indian Journal of Ophthalmology. 2021; 69(3): 701
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42 Impact of lockdown on patients other than COVID-19 in India
AvadheshKumar Yadav
Current Medicine Research and Practice. 2021; 11(6): 298
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43 Turning a New Chapter in Neurosurgery Outpatient Services: Telemedicine A “Savior” in this Pandemic
Amol Raheja, Niveditha Manjunath, Kanwaljeet Garg, Vivek Tandon, Vivek Gupta, Shashwat Mishra, Sameer Ather, Ashish Suri, PSarat Chandra, Manmohan Singh, Ahamadulla Shariff, ShashankS Kale
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44 Ophthalmology practice during COVID-19 pandemic: A survey of Indian ophthalmologists
Pranita Sahay, Namrata Sharma, Rajesh Sinha, MahipalS Sachdeva
Indian Journal of Ophthalmology. 2021; 69(12): 3638
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45 Understanding the changes in practice patterns in ophthalmology following COVID-19 lockdown
AmitC Porwal, JitendraN Jethani, SantoshG Honavar
Indian Journal of Ophthalmology. 2021; 69(10): 2802
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46 Impact of COVID-19 pandemic lockdowns on retinopathy of prematurity services at a tertiary eye care center in India
Ramandeep Kaur, Anusha Sachan, Anu Thukral, Parijat Chandra
Indian Journal of Ophthalmology. 2021; 69(10): 2903
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47 Impact of COVID-19 on follow-up and medication adherence in patients with glaucoma in a tertiary eye care centre in south India
GN Subathra, SharmilaR Rajendrababu, VijayalakshmiA Senthilkumar, Iswarya Mani, B Udayakumar
Indian Journal of Ophthalmology. 2021; 69(5): 1264
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48 Knowledge and Awareness of the Coronavirus Disease and Perceptions Towards Ophthalmic Practice Among Ophthalmologists
Yazan Gammoh
The Open Ophthalmology Journal. 2021; 15(1): 236
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49 Perspectives on Telemedicine during the Era of COVID-19; What Can Saudi Arabia Do?
Ali Mohsen Al-Hazmi, Haytham A. Sheerah, Ahmed Arafa
International Journal of Environmental Research and Public Health. 2021; 18(20): 10617
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50 The Impact of the COVID-19 Pandemic on Ophthalmology Residents: A Narrative Review
Natalia Dub, Joanna Konopinska, Iwona Obuchowska, Lukasz Lisowski, Diana Anna Dmuchowska, Marek Rekas
International Journal of Environmental Research and Public Health. 2021; 18(21): 11567
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51 The impact of the COVID-19 pandemic on microbial keratitis presentation patterns
Gibran F. Butt, Alberto Recchioni, George Moussa, James Hodson, Graham R. Wallace, Philip I. Murray, Saaeha Rauz, Michael Mimouni
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52 The impact of covid-19 on ophthalmic practice in Bangladesh– A cross-sectional study
Syeed Mehbub Ul Kadir, Muhammad Moniruzzaman, Siddiqur Rahman, Khairun Nasa, Tanvir Ahmed, Rajendra Prakash Maurya
Indian Journal of Clinical and Experimental Ophthalmology. 2021; 7(2): 289
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53 Clinical Profile and Practices of Safety Measures of Patients Who Have Attended Outpatient Unit of a Tertiary Care Teaching Hospital in South India during National Lockdown Period
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54 Public perceptions of eye symptoms and hospital services during the first UK lockdown of the COVID-19 pandemic: a web survey study
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55 Telemedicine comes of age during coronavirus disease 2019 (COVID-19): An international survey of oculoplastic surgeons
Elishai Assayag, Maria Tsessler, Lauren M Wasser, Elena Drabkin, Ehud Reich, Yishay Weill, David Zadok, Akshay Gopinathan Nair, Aleza Andron
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56 Ocular surface assessment in times of sanitary crisis: What lessons and solutions for the present and the future?
Marc Labetoulle, Marwan Sahyoun, Antoine Rousseau, Christophe Baudouin
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57 Impact of the COVID-19 pandemic on the activity of private medical practices in Morocco
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58 Effectiveness of simulation-based training for manual small incision cataract surgery among novice surgeons: a randomized controlled trial
Akshay Gopinathan Nair, Chetan Ahiwalay, Ashish E. Bacchav, Tejas Sheth, Van Charles Lansingh, S. Swaroop Vedula, Venudhar Bhatt, Jagadesh C. Reddy, Pravin K. Vadavalli, Smita Praveen, Nikhilesh Anil Wairagade, Jeff Pettey
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59 Effects of the First COVID-19 Lockdown on Ophthalmological Patient Care
Anna Schuh, Stefan Kassumeh, Valerie Schmelter, Lilian Demberg, Jakob Siedlecki, Andreas Anschütz, Thomas Kreutzer, Wolfgang J. Mayer, Thomas Kohnen, Mehdi Shajari, Siegfried Priglinger
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60 Simultaneous Bilateral Central Retinal Artery Occlusion following COVID-19 Infection
Maneesh M Bapaye, Akshay Gopinathan Nair, Charuta M Bapaye, Meena M Bapaye, Juilee J Shukla
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61 “Depression, Anxiety and Stress” in a Cohort of Registered Practicing Ophthalmic Surgeons, Post Lockdown during COVID-19 Pandemic in India
Rohini Grover, Pratham Dua, Supreet Juneja, Lokesh Chauhan, Pradeep Agarwal, Ashi Khurana
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62 Global Ophthalmology Practice Patterns during COVID-19 Pandemic and Lockdown
Srinivasan Sanjay, Seo Wei Leo, Kah - Guan Au Eong, Gitalisa Andayani Adriono, Kenneth CS Fong, Kartik Anand, Rumita S Kadarisman, David B Granet, Padmamalini Mahendradas, Rohit Shetty, Sharon D Souza, Swaminathan P Iyer
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63 Adherence to Urgent Eye Visits during the COVID-19 Pandemic: A Population Characteristics Study
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64 HIV testing & diagnosis in 2020 at the apex tertiary referral hospital of India: impact of COVID-19 pandemic
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65 The impact of COVID-19 on the retina: clinical features and management considerations
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66 The effects of the COVID-19 pandemic on the treatment of allergic eye diseases
Andrea Leonardi, Elena Salami, Oren Mark Feuerman, Fabiano Cavarzeran
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67 The potential impact of 5G telecommunication technology on ophthalmology
Gurfarmaan Singh, Robert Casson, WengOnn Chan
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68 Reply to Letter to Editor “Consequences of a COVID-19 Pandemic on Ophthalmologists”
Sanjay Srinivasan
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69 Urological Surgeries During Exit from National Lockdown During COVID-19 Pandemic
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70 The evolution of the changes in the clinical course: a multicenter survey-related impression of the ophthalmologists at the peak of the COVID-19 pandemic in Turkey
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71 Eye Care During the COVID-19 Pandemic: A Report on Patients’ Perceptions and Experiences, an Asian Perspective
Rebecca Low, Jia Min Lee, Ser Sei Lai, Andrés Rousselot, Manisha Agarwal, Rupesh Agrawal
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72 The impact of COVID-19 outbreak on otolaryngology practice, jordanian experience: A qualitative study
Ahmad Al Omari, Yazan Kanaan, Amjad Nuseir, Ra'ed Al-ashqar, Hasan Al-Balas, Osama Hamarneh, Firas Alzoubi
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73 Family medicine practice challenges during Covid-19 outbreak, curfew and phased re-opening, lessons to be learned from jordanian experience
Hadeel Allan, Thekraiat Al Quran, Mousa Al Omary
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74 Psychological and professional impact of COVID-19 lockdown on French dermatologists: Data from a large survey
L. Misery, J.-W. Fluhr, M. Beylot-Barry, N. Jouan, P. Hamann, S.-G. Consoli, M. Schollhammer, D. Charleux, A. Bewley, D. Rathod
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76 Vitreoretinal surgery tip and tricks in the era of COVID-19
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Graefe's Archive for Clinical and Experimental Ophthalmology. 2020; 258(12): 2869
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77 Impact of COVID-19 on General Surgical Practice in India
Amrit Manik Nasta, Ramen Goel, Manickavasagam Kanagavel, Sundaram Easwaramoorthy
Indian Journal of Surgery. 2020; 82(3): 259
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78 Incorporating Video Visits into Ophthalmology Practice: A Retrospective Analysis and Patient Survey to Assess Initial Experiences and Patient Acceptability at an Academic Eye Center
Gagan Kalra, Andrew M. Williams, Patrick W. Commiskey, Eve M. R. Bowers, Tadhg Schempf, José-Alain Sahel, Evan L. Waxman, Roxana Fu
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79 A novel deep learning conditional generative adversarial network for producing angiography images from retinal fundus photographs
Alireza Tavakkoli, Sharif Amit Kamran, Khondker Fariha Hossain, Stewart Lee Zuckerbrod
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80 Telemedicine for Ayurveda consultation: Devising collateral methods during the COVID-19 lockdown impasse
Sanjeev Rastogi, Neelendra Singh, Preeti Pandey
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81 Challenges and impact of COVID-19 lockdown on Indian optometry practice: A survey-based study
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82 Letter to the Editor: The Use of Telemedicine by Neurosurgeons During the Covid Era: Preliminary Results of a Cross-Sectional Research
Pravesh S. Gadjradj, Roshni H. Matawlie, Biswadjiet S. Harhangi
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83 Neurosurgical Procedures and Safety During the COVID-19 Pandemic: A Case-Control Multicenter Study
Khalid Bajunaid, Ashwag Alqurashi, Abdullah Alatar, Mohammad Alkutbi, Anas H. Alzahrani, Abdulrahman J. Sabbagh, Abdullah Alobaid, Abdulwahed Barnawi, Ahmed Abdulrahman Alferayan, Ahmed M. Alkhani, Ali Bin Salamah, Bassem Yousef Sheikh, Fahad E. Alotaibi, Faisal Alabbas, Faisal Farrash, Hosam M. Al-Jehani, Husam Alhabib, Ibrahim Alnaami, Ikhlass Altweijri, Isam Khoja, Mahmoud Taha, Moajeb Alzahrani, Mohammed S. Bafaquh, Mohammed Binmahfoodh, Mubarak Ali Algahtany, Sabah Al-Rashed, Syed Muhammad Raza, Sherif Elwatidy, Soha A. Alomar, Wisam Al-Issawi, Yahya H. Khormi, Ahmad Ammar, Amro Al-Habib, Saleh S. Baeesa, Abdulrazag Ajlan
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84 Current effect of COVID-19 global pandemic on the professional and life profiles of the Egyptian spine surgeons
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85

A Survey on the Impact of COVID-19 on Lacrimal Surgery: The Asia-Pacific Perspective

Akshay Gopinathan Nair, Natasha Narayanan, Mohammad Javed Ali
Clinical Ophthalmology. 2020; Volume 14: 3789
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86 Ocular oncology practice during SARS-CoV-19 related lockdown
Rajendra P Maurya
Indian Journal of Clinical and Experimental Ophthalmology. 2020; 6(2): 155
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87 Implementation and Usefulness of Telemedicine During the COVID-19 Pandemic: A Scoping Review
María Alejandra Hincapié, Juan Carlos Gallego, Andrés Gempeler, Jorge Arturo Piñeros, Daniela Nasner, María Fernanda Escobar
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88 Strategic use of telemedicine for restarting urological outpatient services during COVID-19 pandemic
Devanshu Bansal, Samit Chaturvedi, Anant Kumar
African Journal of Urology. 2020; 26(1)
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89 Orthoptic Services in the UK and Ireland During the COVID-19 Pandemic
Fiona Rowe, Lauren Hepworth, Claire Howard, Steven Lane
British and Irish Orthoptic Journal. 2020; 16(1): 29
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90 Bariatric Surgery during COVID-19 Pandemic from Patients’ Point of View—The Results of a National Survey
Maciej Waledziak, Anna Rózanska-Waledziak, Michal Pedziwiatr, Jacek Szeliga, Monika Proczko-Stepaniak, Michal Wysocki, Tomasz Stefura, Piotr Major
Journal of Clinical Medicine. 2020; 9(6): 1697
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91 STUDY OF CLINICALAND DEMOGRAPHIC PROFILE OF PATIENTS VISITING A TERTIARY EYE CARE CENTRE ALONG WITH THE EFFECT OF LOCKDOWN DURING COVID-19 PANDEMIC
Kusum Kumari Prasad, Sudeshna Roy, Debalina Ghanta
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92 Teleconsultation at a tertiary care government medical university during COVID-19 Lockdown in India – A pilot study
Nitika Pandey, RajatM Srivastava, Gaurav Kumar, Vishal Katiyar, Siddharth Agrawal
Indian Journal of Ophthalmology. 2020; 68(7): 1381
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93 To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute
Naresh Babu, Piyush Kohli, Chitaranjan Mishra, Sagnik Sen, Dhipak Arthur, Deepesh Chhablani, Girish Baliga, Kim Ramasamy
Indian Journal of Ophthalmology. 2020; 68(8): 1540
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94 Pivoting to teleconsultation for paediatric ophthalmology and strabismus: Our experience during COVID-19 times
AjinkyaV Deshmukh, Akshay Badakere, Jenil Sheth, Manjushree Bhate, Sampada Kulkarni, Ramesh Kekunnaya
Indian Journal of Ophthalmology. 2020; 68(7): 1387
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95 Commentary: Teleophthalmology: Opportunities and challenges
Jayesh Vazirani
Indian Journal of Ophthalmology. 2020; 68(7): 1379
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96 Prepare or perish - Readiness is the key to reopen for routine eye care
SantoshG Honavar
Indian Journal of Ophthalmology. 2020; 68(5): 677
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97 The impact of COVID-19 related lockdown on ophthalmology training programs in India – Outcomes of a survey
Deepak Mishra, AkshayGopinathan Nair, RashminAnilkumar Gandhi, ParikshitJ Gogate, Satanshu Mathur, Prashant Bhushan, Tanmay Srivastav, Hemendra Singh, BibhutiP Sinha, MahendraKumar Singh
Indian Journal of Ophthalmology. 2020; 68(6): 999
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98 Perspectives of physicians in general and ophthalmologists in particular about restarting services post-COVID-19 lockdown
VG Madanagopalan, MR Sriram Gopal, Sabyasachi Sengupta
Indian Journal of Ophthalmology. 2020; 68(7): 1401
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99 Changes in the interaction of ophthalmologists and ophthalmic industry during and after COVID-19 lockdown: A perspective
Srinivasan Sanjay, Arushi Garg, Naren Shetty, Rohit Shetty, Narendra Pindipapanahalli, KBhujang Shetty
Indian Journal of Ophthalmology. 2020; 68(7): 1487
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100 “Am I audible? Are my slides visible?” – Do we need to flatten the webinar curve?
AkshayGopinathan Nair
Indian Journal of Ophthalmology. 2020; 68(11): 2341
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101 Guidelines for the management of ocular trauma during the COVID-19 pandemic
Sundaram Natarajan, AkshayGopinathan Nair, Raghuraj Hegde, Gangadhara Sundar, ManeeshM Bapaye, Gobinda Mukherjee, Purendra Bhasin, MahipalS Sachdev, Namrata Sharma, Rajesh Sinha, AIOS Writing Group
Indian Journal of Ophthalmology. 2020; 68(11): 2483
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102 Assessment of online teaching as an adjunct to medical education in the backdrop of COVID-19 lockdown in a developing country – An online survey
Devanshi Desai, Saswati Sen, Sanjiv Desai, Ranjana Desai, Snehalata Dash
Indian Journal of Ophthalmology. 2020; 68(11): 2399
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103 Commentary: COVID-19 pandemic and national lockdown: The cascading effect
Rinky Agarwal, Namrata Sharma
Indian Journal of Ophthalmology. 2020; 68(8): 1545
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104 Managing vitreoretinal surgeries during COVID-19 lockdown in India: Experiences and future implications
Divya Agarwal, Rohan Chawla, Toshit Varshney, Nawazish Shaikh, Parijat Chandra, Atul Kumar
Indian Journal of Ophthalmology. 2020; 68(10): 2126
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105 All India Ophthalmological Society - Oculoplastics Association of India consensus statement on preferred practices in oculoplasty and lacrimal surgery during the COVID-19 pandemic
MohammadJaved Ali, Raghuraj Hegde, AkshayGopinathan Nair, MandeepS Bajaj, SubhashM Betharia, Kasturi Bhattacharjee, ApjitK Chhabra, JayantaK Das, Gagan Dudeja, AshokK Grover, SantoshG Honavar, Usha Kim, Lakshmi Mahesh, Bipasha Mukherjee, Anita Sethi, Mukesh Sharma, Usha Singh
Indian Journal of Ophthalmology. 2020; 68(6): 974
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106 Effect of COVID-19 on ocular diseases and ophthalmology residency training program-A developing country's perspective
Bhagabat Nayak, Saswati Sen, Sucheta Parija
Indian Journal of Ophthalmology. 2020; 68(7): 1491
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107 Silent casualty of COVID-19: Training and education
JavedHussain Farooqui, Sima Das, Shalinder Sabherwal, Umang Mathur, Sana Iqbal
Indian Journal of Ophthalmology. 2020; 68(6): 1218
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108 Commentary: What happens after the lockdown?
Chaitra Jayadev, Rohit Shetty
Indian Journal of Ophthalmology. 2020; 68(5): 730
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109 Impact of COVID-19 on a tertiary eye hospital
Srinivasan Sanjay, Arushi Garg, Rohit Shetty, Naren Shetty, BhujangK Shetty
Indian Journal of Ophthalmology. 2020; 68(7): 1485
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110 Problems of management of non-corona respiratory diseases in the era of COVID-19
SurinderK Jindal, Aditya Jindal, Subhabrata Moitra
International Journal of Noncommunicable Diseases. 2020; 5(2): 63
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111 Impact of COVID-19 pandemic, national lockdown, and unlocking on an apex tertiary care ophthalmic institute
Rinky Agarwal, Namrata Sharma, Anuja Patil, Himani Thakur, Rohit Saxena, Atul Kumar
Indian Journal of Ophthalmology. 2020; 68(11): 2391
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112 COVID casualty: Bilateral blindness due to ingestion of spurious sanitizer
Lav Kochgaway, AkshayGopinathan Nair, Ankita Mitra, Sagar Bhargava, Maneesh Singh
Oman Journal of Ophthalmology. 2020; 13(3): 164
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113 COVID-19: Precautionary Guidelines for Ophthalmologists
Hani B ALBalawi
Cureus. 2020;
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