There are several things about the current COVID-19 pandemic that are not well-understood and hence the guidelines have been evolving over a period of time. Different countries have adopted various strategies, and these could lead to variation in the safety protocols

Written by Dr Jagadesh Reddy

Cataract, which leads to cloudy vision, is caused due to the opacification of the natural lens in the eye. Common among the elderly, cataract surgery is one of the most commonly performed procedures across the world, and its management has evolved from a stage of visual restoration to a stage of refractive surgery.

Cataract is the second leading cause of preventable blindness in the world. Among the global population (2015) with moderate or severe vision impairment or complete vision loss, cataract accounted for 52·6 million and 12·6 million, respectively. By 2020, among the global population with moderate or severe vision impairment and blindness, the number of people with cataract is anticipated to increase to 57·1 million and 13·4 million respectively. In order to decrease the burden of visual impairment or blindness due to cataract, there has been a lot of emphasis on improving cataract surgical coverage and cataract surgical rates in India by various national and international agencies. In spite of all these efforts, cataract continues to be a major cause of visual impairment and blindness due to the rapidly aging population.

Recent data (2018-2019) from the National Programme for Control of Blindness (NPCB) shows that on average about 5,57,568 cataract surgeries are performed per month in India. The recent onset of COVID-19 pandemic has led to the closing of the screening programmes and surgical centres across the country, thus further compromising the achievement of set goals. Due to the initial complete shutdown of surgery services and the continued slow increase in the number of procedures done, there is a significant backlog of surgeries to be cleared.

There are several things about the current COVID-19 pandemic that are not well-understood and hence the guidelines have been evolving over a period of time. Different countries have adopted various strategies, and these could lead to variation in the safety protocols.

The most important factor preventing healthcare workers from starting routine work is the risk of cross-infection due to COVID 19. Several measures can be taken at different points to decrease it:

While booking appointments, the necessary history of a patient and family member’s well-being should be emphasised.

Hospital premises: If any patient has any symptoms, they should be examined in an isolation room.

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Clinic visit

*All health care workers should have necessary personal protective equipment at all times.
*Digital payment methods and self-check-in kiosks should be available in the clinic to minimise physical contact with any object or personnel.
*Appointments should be staggered to maintain social distancing in the waiting halls
*All elderly patients (80 years and above) should be examined on high priority to minimise their stay in the hospital.
*Modification should be done in the examination process to minimise patient movement between rooms and the need for any test that requires contact with the patient. Complete preference should be given to non-contact tests.
*Planning surgery: In case a patient requires a cataract surgery every attempt should be made to complete the necessary planning on the same day. In case the patient needs additional systemic workup, a provision should be made to get the same with his/her physician closer home and share the documents with the hospital.

Surgery

*Number of surgeries should be reduced to avoid gathering.
*Modifications should be incorporated in the steps of the surgery which minimises the duration of the procedure or generation of aerosols.
*Disposable material should be used wherever applicable.
*Operating room should be cleaned after every case.
*Necessary time gap of 20-30 minutes between each procedure should be maintained.

Telemedicine is also used as a form of consultation resulting in decreasing the need for physical consultation thus avoiding the risk of cross-infection for patients and health care professionals. It can also help to identify patients who need physical consultation for the evaluation of cataract.

After surgery, patients can opt for telemedicine for follow-up consultation. Product development and validation of homecare devices is ongoing and would be available soon for regular use.

The author is head of cataract and refractive service, L V Prasad Eye Institute, Hyderabad

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