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Canadian Eye and Tissue Bank Operational Status Update
March 24, 2020
| Province | Program Status March 24, 2020 |
| British Columbia | The Eye Bank of BC is continuing to recover, albeit at a reduced level. During this time, BC is deferring all respiratory-related deaths and those from ICUs; and will be asking supplemental Med/Soc questions (1. Has the donor been diagnosed with or suspected to have had COVID-19 in the past two months; 2. Has to donor had any contact with someone diagnosed with or suspected to have had COVID-19 in the past 28 days; 3) Did the donor have any of the following symptoms in the past 28 days: fever, dry cough, or shortness of breath; 4. Did the donor travel outside of Canada in the past 28 days; and 5. Did the donor have any contact with someone who travelled outside of Canada in the past 28 days). A positive response to Q#1 is an automatic deferral, positive responses for any other questions will be sent for a medical director consult. |
| Alberta North | CTC is still recovering tissue. Cornea transplants are on hold as an elective procedure, so CTC has no need to recover corneas. CTC is determining its approach to have emergent supply on hand but will likely continue with a limited recovery program in order to have corneas on hand for emergencies. |
| Alberta South | |
| Saskatchewan | Eye bank has suspended recovery. |
| Manitoba | Tissue Bank Manitoba: Currently business as usual. Remembering that we are a recovery agency & allograft distributor, not a source establishment, here is my update: Allograft Distribution: 0 = Surgeries canceled or delayed4 donors in the last 8 days (this is high for us, normally we do 4 a month –people are feeling very generous right now)Enhanced Covid-19 screening as per Health Canada, AATB etc. Experiencing slight delays at US border, but not significant enough to impact operations; 0 issues with materials or supplies; We are currently supplied for ~3 months.In anticipation of this event I increased our allograft inventory by ~25% three weeks ago, so no anticipated issues thereAll staff present and accounted for, not a single part-time/full-time staff member has requested leave for child care or other Modifications to our service are minimal: No visitors allowed in the facilityModified shift schedule to reduce the amount of people at work at one timeReduction on face-to-face meetings, any necessary huddles/meeting is held in lobby or from office door, where ample space is availableGeneral reminders around use of universal precautions At this time we are not planning to alter our services, however that status could change at any time as the situation evolves. We anticipate that this event will last for months and will continue to provide service as we are able. Misericordia Eye Bank Eye Bank is limiting recovery based on the Donor Assessment record and 28-day criteria of EBAA. Are being cautious with tissue recovery as we will need tissue for emergency cases when those occur. Frozen would be the first choice as we have a supply of frozen globes and amnion. |
| Ontario | Screening Changes: TGLN using 28 days threshold free of any respiratory symptoms, etc. Ocular Recovery: Eye Bank had a potential staff exposure so temporarily not receiving tissue. As of March 23rd Eye Bank is now prepared to receive tissue. TGLN working through recovery staff concerns before re-starting recoveries and providing education on the new screening. Expected date to re-start recoveries for emergency use is March 25 or 26 assuming decision to move forward. Recovery of whole globe to meet emergency ocular surgery needs using revised screening criteria. All other ocular recoveries deferred. Elective eye surgeries cancelled throughout the province. Recovery to be completed at TGLN’s surgical suite, not hospitals Multi Tissue Recovery: Recovery as in the past using revised screening criteria.Donations continue but reduced volume. Recovery completed at TGLN recovery suite, not hospitals. |
| Quebec | No tissue recovery is being performed at hospitals, donors are transported to our facilities to limit the travel and exposure of recovery staff. Staff are asked to stay home or are reassigned to other departments. Multi-tissue activity reduced to week-days only (recovery and processing day and evening shifts). Reduced but will ensure heart, skin and eye recovery.Will maintain a limited supply of cornea, mainly for urgent tissue requests.Hospitals have cancelled non-urgent surgeries, resulting in 25 corneal transplants cancelled this week. If the situation worsens the need for tissue will be minimal and the tissue bank will reduce its activities further and prioritize life-saving tissues (skin grafts and pediatric heart valves) It will be increasingly difficult to qualify tissue donors in those that have been infected or in contact with infected people. There is a recommendation to limit movement from one region to another within the province, and in the event, travel is prohibited, this will reduce the number of donors. Have added two new specific qualifying questions: have they been diagnosed or expected diagnosed with COVID 19 (28-day deferral) and has there been contact or have they been ordered to quarantine. Following the recommendation from Public Health, they will be modifying the deferral period to 14 days. |
| New Brunswick | As of Feb. 27th, new questions were added to the DRAI (in accordance to EBAA & AATB recommendations).On March 16th, under the guidance of our Medical Director, Dr Seamone, and in consultation with Nova Scotia Health’s Regional Tissue Bank (where most corneas recovered in NB are sent for processing and allocation), we suspended all ocular tissue recovery in consideration of the following: OR now being restricted to urgent and emergent cases only (hence no corneal transplant surgeries) and some frozen tissue being available (for tectonic use).The NBOTP-Ocular Division has no corneal tissue in the bank. Some NB tissue has been frozen and available from Regional Tissue Bank. For MS tissue, because of the same reductions taking place in NB’s Horizon Health Network (cancellation of elective surgeries) and the fact that, for NBOTP, Eye Bank Technicians are responsible to perform initial screening for MS tissue donors, under the guidance of our Medical Director, Dr Mitton, we have also decided to suspend MS tissue recoveries temporarily.We do have some tissues on inventory which can be shipped to NB facilities sill ordering these; our current inventory consisting mostly of bone products (cancellous chips, femoral & tibial struts, femoral heads, tricortical wedges, fibula segments, with some hemi-patellar tendons). |
| Nova Scotia | Has suspended all eye and tissue recovery as COVID continues to spread. Decision is based on risk assessment to staff, patients and in relation to utilization of resources.Bank PPE and supplies may be redirected to patient care. Suspension is expected to be extended as COVID continues to spread. |
New Recommendations Regarding Urgent and Nonurgent Patient Care from AAO
Due to the COVID-19 pandemic, the American Academy of Ophthalmology now finds it essential that all ophthalmologists cease providing any treatment other than urgent or emergent care immediately.
We now live and practice in a critically different medical reality—a rapidly evolving viral pandemic that is projected to, if unchecked, kill millions of Americans and tens of millions around the world. Public health experts agree that we must do two things on an urgent basis:
First, we must reduce the risk of the SARS-CoV-2 virus transmission from human to human and the rate of new case development. Only in that way can we flatten the curve and not overwhelm our very limited supply of hospital beds, ICU beds, ventilators and extracorporeal membrane oxygenation (ECMO) machines. We have already hit that stage in a few hard-hit metropolitan areas.
Second, we must as a nation conserve needed disposable medical supplies and focus them to the hospitals where they are most needed.
This disease is now in every state and the number of new cases is currently doubling every one to two days. Already, a handful of our ophthalmologist colleagues have died from COVID-19. It is essential that we as physicians and as responsible human beings do what we can and must to reduce virus transmission and enhance our nation’s ability to care for those desperately ill from the disease. Public health experts unanimously agree that our window to modify the spread of disease is a narrow and closing one.
Accordingly, the American Academy of Ophthalmology strongly recommends that all ophthalmologists provide only urgent or emergent care. This includes both office-based care and surgical care. The Academy recognizes that “urgency” is determined by physician judgment and must always take into account individual patient medical and social circumstances. Each of us has a societal responsibility to not function as a vector of a potentially fatal disease—and one for which a widely available treatment or vaccine does not currently exist.
All other factors—business, finance, inconvenience, etc.—are remotely secondary. This is an existential crisis. We as physicians must respond to it and support our colleagues and our communities. Be safe.
Access Details
For additional information go to aao.org/coronavirus.
AAO’s Clinical Coronavirus Resources for Ophthalmologists
The AAO has created a portal for ophthalmologists to receive daily updates on COVID-19, including information on how to keep Ophthalmologists and their patients safe.
Coronavirus and Eye Care
CDC Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
This interim guidance has been updated based on currently available information about COVID-19 and the current situation in the United States, which includes community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), eye protection, gloves, and gowns.
3 videos to MAKE your own slit lamp protectors
3 videos on how to make-it-yourself, universal slit-lamp and microscope shield for eye care professionals: ophthalmologists, optometrists.
https://www.youtube.com/watch?v=wvnx_KIUE9A
https://www.youtube.com/watch?v=pXm624pBDUM
https://www.youtube.com/watch?v=G5wxU2UV0nI
Recommended Protocol for Suspect or Confirmed COVID-19 Patient Use CONTACT and DROPLET PRECAUTIONS with Eye Protection
Practical Ergonomic and Mindfulness Tips for a Day in the Operating Room
The Canadian Ophthalmological Society is pleased to provide you to a recording of the webinar on practical ergonomic tips in the ophthalmology operating room, that took place on December 9, 2019.
In the session George Matos, Musculoskeletal Injury Prevention Specialist and ophthalmologist Dr. Lorne Bellan review how to adapt your posture to protect yourself through a day of surgery. This webinar includes thoughts to have in mind at the start of your surgical day, including how to set up your foot pedals, chair, operating table and surgical microscope, each to optimize your posture and support during your day of surgery and to minimize the risk of repetitive stress injuries.
IHI Videos for Improving Joy in Work
1. Four Steps Leaders Can Take To Increase Joy In Work
IHI Director Jessica Perlo, co-author of the IHI White Paper, shares four steps leaders can take to help their staff find joy and meaning in their work.
2.How To Get Ready For “What Matters To You?” Conversations
The first step to improving joy in work is for leaders to engage colleagues to identify what matters to them in their work. Jessica Perlo, IHI White Paper co-author, describes three actions to help leaders prepare for these conversations.
Access Details
For more information about IHI Framework for Improving Joy in Work please visit: http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Improving-Joy-in-Work.aspx
February 2020 Issue Highlights
The February 2020 issue of the Canadian Journal of Ophthalmology (CJO) is now available online and we are pleased to unveil our new look for 2020.
What’s in the February issue?
Resident Perspectives + visual abstract: Our talented team of residents have summarized 5 articles from the issue, with a focus on topics and issues that are relevant to learners here in Canada and around the globe. And the February visual abstract provides a graphical summary of the article, Pentosan-associated maculopathy: prevalence, screening guidelines, and spectrum of findings based on prospective multimodal analysis.
Special supplement on Tele-Retina Screening for Diabetic Retinopathy: This timely supplement includes an editorial from the CJO Editor-in-Chief, two original research articles, and evidence-based guidelines from the Canadian Retina Research Network (CR2N) Tele-Retina Steering Committee. The supplement will be freely available until the end of 2020.
Review articles, original research, and lots more, including:
- Competency-based medical education in ophthalmology residency training: a review
- Novel imaging modalities in patients with uveitis
- Ocular and facial injuries sustained by goaltenders in the National Hockey League: a preventable problem
- Impact of eyeglasses on academic performance in primary school children
- Optical coherence tomography as a tool to detect early sympathetic ophthalmia in an asymptomatic patient
- Foreign body extrusion associated with N-butyl-2-cyanoacrylate glue used with rectus muscle hang-back recession
Follow the CJO on Twitter (@CanJOphth) and Instagram (@cjo_jco).