Disinfection Recommendations from the Manufacturers: Haag-Streit and Zeiss

May 5, 2020

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

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Recommendations for Conducting Vitreoretinal Surgery During the COVID-19 Pandemic

April 30, 2020

The CRS Executive has reviewed and supports the recommendations of the American Society of Retinal Specialists (ASRS) for conducting vitreoretinal surgery during the COVID-19 pandemic. The CRS endorses these ASRS recommendations for application within the Canadian context.

Read the full ASRS recommendations for conducting vitreoretinal surgery during the COVID-19 pandemic

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Canadian Society of Oculoplastic Surgery Position Statement: Guidelines on Personal Protective Equipment (PPE) during COVID-19 Pandemic for Oculoplastic and Orbital Surgery

April 28, 2020

Guidelines on Personal Protective Equipment (PPE) during COVID-19 Pandemic for Oculoplastic and Orbital Surgery

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Background

The Canadian Society of Oculoplastic Surgery has evaluated the current literature assessing the risk to ophthalmologists who perform oculoplastics procedures during and after the current pandemic. Using the best evidence available, guidelines on the minimum personal protective equipment that surgeons should employ were developed. The attached statement has been endorsed by the COS Board of Directors. These comments and recommendations are based on the “conditions on the ground” that exist today at the time of this writing.

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Read the full position statement from the Canadian Society of Oculoplastic Surgery

International Uveitis Study Group Document Collection About the Care of Uveitis Patients in the COVID-19 Pandemic

COVID-19 Document Library

Additional Considerations to Help Manage the Anti-VEGF Injection Burden during the COVID-19 Pandemic

April 4, 2020

Background

At the Association of Canadian University Professor of Ophthalmology (ACUPO) teleconference on March 24, 2020, Canadian Department Heads were interested in developing recommendations to assist balancing crucial reductions in anti-VEGF treatment volumes, driven by the COVID-19 virus, with essential treatments still needed for sight preservation. Following a literature review focusing on randomized clinical trials, the following recommendations were developed. Subsequently, the document was reviewed by ACUPO and the Canadian Ophthalmological Society (COS) for feedback.

This document Additional Considerations to Help Manage the Anti-VEGF Injection Burden during the COVID-19 Pandemic is supplementary to and expands on the foundational CRS March 19, 2020 Canadian Retina Society (CRS) Position Statement on Intravitreal Injections and the Management of Retinal Diseases during the COVID-19 Crisis. Both documents can be found on the COS Practice Resource Center. The data and suggestions that follow, as always, do not replace appropriate clinical judgement; clinicians will need to consider the specifics of each patient’s unique ocular and systemic health status and provide care that is in the patient’s best interest.

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Read the full statement for the Additional Considerations to Help Manage the Anti-VEGF Injection Burden during the COVID-19 Pandemic.

Canadian Glaucoma Society Recommendations for Providing Eye Care to Glaucoma Patients During COVID-19 Pandemic

April 16, 2020

Background

The COVID-19 Pandemic has led to widespread implementation of physical isolating measures and cessation of non-urgent medical visits and procedures. This document is to provide guidance to physicians caring for glaucoma patients to help mitigate the risk to patient and care provider while balancing the need for treatment to preserve vision. As this is a rapidly evolving health care crisis, these recommendations may be modified, and we urge all clinicians to use their own best judgement to individually manage patient care with best practices in mind. These recommendations are based upon and supplemental to the March 20, 2020 COS and ACUPO Guidelines for Ophthalmic Care during COVID-19 Pandemic and guidelines from American Academy of Ophthalmology, and the United Kingdom National Health Society guidelines.

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Read the full recommendations from the Canadian Glaucoma Society.

The Canadian Glaucoma Society Recommendations for Providing Eye Care to Glaucoma Patients During COVID-19 Pandemic was endorsed by the Canadian Ophthalmological Society (COS) and the Association of Canadian University Professors of Ophthalmology (ACUPO) on April 9, 2020.

COS and ACUPO Guidelines for Ophthalmic Care during COVID-19 Pandemic

March 20,2020

Background

We are in the midst of a global crisis, which changes daily. Our federal, provincial, local, hospital, and university authorities provide mandates and recommendations that are applicable to the practice of medicine during the COVID-19 pandemic. The purpose of the guidelines below is not to replace those mandates and recommendations, but to add those specifically relevant to the practice of ophthalmology. The guidelines reflect a collaborative effort among the Canadian Ophthalmological Society, the Association of Canadian University Professors of Ophthalmology, and subspecialty societies. The American Academy of Ophthalmology guidelines at www.aao.org/headline/alert-important-coronavirus-context are also useful for the context of ophthalmic care, and were useful in the development of the guidelines below.

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Read the full COS and ACUPO Guidelines for Ophthalmic Care during COVID-19 Pandemic

Lacrimal irrigation /Surgery/Manipulation During the COVID-19 Pandemic

April 7, 2020

The Canadian Society of Oculoplastic Surgery and the Canadian Association of Pediatric Ophthalmology and Strabismus have evaluated the management of lacrimal disorders and the risks to ophthalmologists during this COVID crisis. The attached statement has been endorsed by the COS Board of Directors. These comments and recommendations are based on the “conditions on the ground” that exists today at the time of this writing.

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Read the full Position statement on Lacrimal irrigation/Surgery/Manipulation During the COVID-19 Pandemic

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. 27^th, new questions were added to the DRAI (in accordance to EBAA & AATB recommendations).On March 16^th, 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.