May 5, 2020

Guidance During COVID-19: Disinfection Recommendations from the Manufacturers – Haag-Streit and Zeiss

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• COVID-19 guidance: Cleaning your HFA Perimeter
• Considerations on How to Clean Perimeters to Lower the Risk of COVID 19 Transmissions
• Cleaning Guidance for the Humphrey Field Analyzer (HFA)

The April 2020 issue of the Canadian Journal of Ophthalmology (CJO) is now available online. Here are just some of the highlights in this issue:

Resident Perspectives + visual abstract: In this issue, our residents have summarized 5 articles that they feel are relevant to learners here in Canada and around the globe, including the article featured in our April visual abstract, Effect of 6-week washout period on intraocular pressure following chronic prostaglandin analogue treatment: a randomized controlled trial.

F.Y. Eye column: As always, we’re pleased to feature Dr. Ian McIlraith’s column, which summarizes recent research and news stories that might be of interest to ophthalmologists. This month, he looks at publications on neuromyelitis optica disease progression, optic nerve ultrasonography for diagnosing increased intracranial pressure, and idiopathic intracranial hypertension as a risk factor for cardiovascular disease.

An excellent line-up of review articles, original research and more, including:

• Dry eye after refractive surgery: a meta-analysis
• Vision to improve: quality improvement in ophthalmology
• The effect of pharmacological pupillary dilation on intraocular pressure measurement
• Pentosan-associated maculopathy: prevalence, screening guidelines, and spectrum of findings based on prospective multimodal analysis
• Ophthalmology referral as part of a multidisciplinary approach to suspected abusive head trauma
• Recovery of stereopsis after strabismus surgery in X-linked ocular albinism 
• Inner-limiting-membrane peeling in epiretinal membrane surgery: an evolving surgical trend

Follow the CJO on social media:

Twitter: @CanJOphth

Instagram: @cjo_jco

Facebook: CanJOphth

Recommended COVID-19 Resources

On 11 March 2020, World Health Organization (WHO) declared that the COVID-19 outbreak was a pandemic. What seemed to be overnight, our clinical, academic and personal lives turned upside down grappling with this new reality. COVID-19 has and will continue to impact communities and cities across Canada.  

Ophthalmologists – not unlike our colleagues across medicine – have many questions. How do I protect myself and my patients from COVID-19? How do I decide which clinical activities to continue and which to temporarily put on hold? Are there unique ocular implications of COVID-19?

These are some of the many questions we are facing. While there are no easy answers, there are several resources available to guide Canadian ophthalmologists in navigating these unchartered waters. The Practice Resource Committee (PRC) has compiled a list of some available resources for use. With this pandemic evolving ever so quickly, new and updated resources will become available. Please continue checking this page to stay informed on the latest recommendations to assist you in your practice and feel free to drop us a line if you come across a resource you would like to suggest. Finally, we also strongly encourage you to refer to your provincial or territorial guidelines for the standards that apply to you and your practice.

Canadian

• COS and ACUPO https://cosprc.ca/resource/guidelines-for-ophthalmic-care/
• Institut national de santé publique du Québec https://www.inspq.qc.ca/sites/default/files/covid/2957-mesures-exceptionnelles-equipements-protection-individuelle-covid19.pdf

American

• AAO: https://cosprc.ca/resource/aaos-new-recommendations-regarding-urgent-and-nonurgent-patient-care/

Retina

• Retina International: http://www.retina-international.org/statement-from-retina-international-and-its-scientific-and-medical-advisory-board-on-covid-19/
• https://cosprc.ca/resource/canadian-retina-society-crs-position-statement-on-intravitreal-injections-and-the-management-of-retinal-diseases-during-the-covid-19-crisis/

Uveitis

• International Uveitis Study Group:  https://www.iusg.net/library

Resources for your practice

International

• International Agency for Prevention of Blindness: https://www.iapb.org/news/covid-19-resources-here-is-what-we-know/
• French Society of Ophthalmology: http://www.icoph.org/downloads/French-Society-of-Ophthalmology-COVID-19-Guidelines.pdf
• Mexican Society of Ophthalmology: https://www.smo.org.mx/
• Philippine Academy of Ophthalmology: https://pao.org.ph/public/

Self-care

• https://cdn-contenu.quebec.ca/cdn-contenu/sante/documents/Problemes_de_sante/19-210-30A_Guide-auto-soins_anglais.pdf?1584985885

Recommended by Zainab Khan, MD, FRCSC
Practice Resource Centre Committee Member, Canadian Ophthalmological Society

Wellness during the pandemic

If there was ever a time for physicians to take one’s physical and mental health seriously, it is now.

This situation may last for weeks and quite likely months.  The WHO warns us to prepare for “a marathon, not a sprint”.

 We will be facing difficult decisions that can create distress. How long can our patients safely wait with ‘non emergent’ problems? How will we cope with and manage the backlog of patient visits and surgeries once things are back to “normal”? Do we lay off techs/office staff during the slowdown, and if so- how will they manage financially with the loss of employment?

Trainees are dealing with uncertainty and disruption of their training and future employment- especially those that have been preparing for their Royal College exams. Further Information: https://residentdoctors.ca/

Of course, there is also the constant worry that we or a family member may test positive, or that we could unknowingly be a vector for transmission.

Remember to:

Take appropriate precautions at work

• Use the required personal protective equipment, including sanitizer, masks, sneeze shield for the slit lamp 
  Further Information: https://cosprc.ca/resources/type/for-learners/covid-19/

Take appropriate precautions outside of work to not infect others

• Proper hand and cough hygiene
• Cleaning surfaces often
• Physical distancing

 Support your family’s health and wellness

• Be sure they are aware of the precautions to reduce spread
• Consider hand washing, changing clothing, removing shoes and showering as soon as you arrive home
• Have a plan in place if someone in the household becomes symptomatic or tests positive

 Take care of your own health and wellness

• Use strategies that work for you – and make time for things you enjoy
• Keep a healthy lifestyle (rest, eat well, exercise etc.)
• Take breaks from reading, listening or watching news stories about the pandemic
• Consider downloading one of the subscription apps that are offering free access to healthcare providers to improve access to coping strategies, such as CalmHealth and Ten Percent Happier
• Be alert to signs of fatigue, stress, anxiety, irritability and burnout
• Stay connected to others. Consider reaching out virtually to family, friends and other colleagues

Remember there are provincial physician resource programs to support you if needed. Don’t be afraid to ask for help if you need it.

Some additional references and resources:

Video Webinar: Coping with Uncertainty about the Coronavirus, ComPsych, March 2020
https://hr.uw.edu/benefits/uw-carelink/webinar-coping-with-uncertainty-coronavirus-covid-19

Mental Health and Psychosocial Considerations During COVID-19 Outbreak, WHO, March 12, 2020
https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_10

Resilience and stress inoculation during COVID-19, Ontario Medical Association
https://dfcm.utoronto.ca/sites/default/files/physician_resilience_and_stress_incoculation.pdf

A clinician’s guide: managing COVID-19 stress and anxiety, Canadian Medical Association
https://boldly.joulecma.ca/home/managing-covid-19-stress-and-anxiety

CDC Resources

1. https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html 
2. https://emergency.cdc.gov/coping/responders.asp   

Doctors Manitoba
https://doctorsmanitoba.ca/wp-content/uploads/2020/03/COVID-19-PHW-Guide-FINAL.pdf

Headspace
https://www.headspace.com/ 
(Free access for all healthcare professionals right now)

COS Physician Wellness Steering Committee
Dr. Lisa Gould, Chair
Dr. Rishi Gupta
Dr. Lorne Bellan
Dr. Colin Mann

March 27, 2020

Dr. Mamta Gautam, is an Ottawa-based psychiatrist, known as the Doctors’ Doctor, with expertise in physician health and physician leadership.  She is hosting a free daily Zoom call to offer mutual peer support to colleagues as we deal with COVID19.

-Zoom call, at 4 pm EST for 1 hour, 7 days/week

-Please feel free to drop in, as often as you want, for as long as you want. No commitment.

-This is not therapy or psychiatric care, just peer support.

-While unable to guarantee confidentiality, Dr. Gautam is doing her best to ensure privacy.

-It will not be recorded in any way.

Please email her at [email protected]  for the link and password for access to the Zoom calls.

As individual physicians, we can practice strategies to increase and maintain our personal resilience. Feeling stress does not mean we are not coping well or not able to do our job. In fact, it is a normal human response, and may be useful in allowing us to function during this difficult time. The important thing is to manage it effectively so that stress does not become distress. Using the 5 C’s of Resilience framework (1), there are tangible things we can do to remain well.

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Read the full article here.

This playbook was written to help Canadian physicians introduce virtual patient encounters into their daily practices. It is intended to be virtual care platform and vendor agnostic. It focuses on video visits, though phone calls and patient messaging are also categorized as virtual care.

While not exhaustive, the playbook covers all key considerations to succeed at providing safe, effective and efficient care:

• Fitting virtual care into your practice workflow

• Technology requirements

• Scope of practice — what problems can be safely assessed and treated

• “Webside” manner

• The virtual visit from beginning to end

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Read the full Canadian Medical Association’s Virtual Care Playbook

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html#a1

The Wills Eye Knowledge Portal provides free online learning for ophthalmologists.

Featured Content Includes

• Free online education

• Surgical Videos

• Visiting Professor Series

• Lectures for Residents (BCSC Series)

• Live Streamed Chiefs’ Rounds

• Newsroom commentary on trends and treatments in ophthalmology

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To access the courses on the Wills Eye Knowledge Portal please visit: www.willseyeonline.org.