The impact of COVID-19 on Chinese ophthalmology at the start of the pandemic

Reviewed by Dr Ningli Wang.

The onset of the COVID-19 pandemic had a profound effect on medicine and eyecare worldwide. In a recent study, Dr Ningli Wang, director of Beijing Tongren Eye Center, China, described its impact on ophthalmology in China.

Ophthalmologists as a group had the highest risk of contracting the COVID-19 virus because of the close proximity between clinicians and patients during ocular examinations. To define the risk, Dr Wang and his colleagues sent a cross-sectional case-control questionnaire to 10 hospitals to investigate the incidence and distribution of symptomatic virus in eye professionals in Wuhan, China, between 26 February and 20 March 2020.

The questionnaire collected information on demographics, personal protective equipment and hand hygiene. “The goal was to improve safety among eye professionals working during the pandemic,” Dr Wang said. The results showed that two of the 10 hospitals in the area covered by the study were hit especially hard because they were situated close by (4.5 km) to the Hunan Seafood Wholesale Market, where the early viral outbreak was reported.

“The overall incidence of symptomatic COVID-19 was 2.52% among eye professions as compared with 2.27% among all healthcare workers, indicating the higher risk of contracting the virus among ophthalmologists,” Dr Wang said. In the hospitals surveyed, 28 cases of the virus were found in eye professionals.

The risk factors identified for the incidence of COVID-19 among ophthalmologists were older age, longer time in practice, lack of sleep, lack of protective equipment and higher rates of contact with patients with suspected or confirmed COVID-19. “The incidence of COVID-19 peaked during the early phase of the pandemic and decreased significantly 2 weeks after lockdown,” Dr Wang said. During lockdown, only cases requiring emergent care were examined in clinics.

Ocular symptoms

The ocular manifestations of COVID-19 were keratoconjunctivitis; scleritis; uveitis; central retinal vein occlusion; optic neuritis; cranial nerve palsy; and Miller Fisher syndrome. The clinical signs lacked specificity, however, and were seen as either the initial manifestation, concomitant with other symptoms, or the only symptom. This presentation increased the difficulty in diagnosing COVID-19 infection.

Dr Wang explained that the prevalence rate of conjunctivitis and/or conjunctival congestion was 8%; other prevalence rates were foreign body sensation at 6%, increased secretion at 10% and ocular itching at 9%. However, the ocular symptoms were present less often than other symptoms, such as fever, coughing and fatigue.

Chinese practice patterns and precautions

Dr Wang reported that the most important practices for ophthalmologists are disinfecting hands and equipment after examinations, use of a protective shield, alternative examination methods to ensure safe distancing and ventilation. For other healthcare workers, the safety measures included using personal protective equipment, checking temperatures at least twice daily, stopping working in the presence of symptoms and maintaining a distance of 1.5 m from patients during visits.

For the general public, there is a low risk of contracting COVID-19 through ocular transmission; wearing a mask, careful hand washing and wearing goggles in high-risk areas are important safety precautions. Dr Wang cautioned that the exact mechanisms of ocular transmission and ocular damage are unknown.

“Long-term ocular complications need further observation,” he said. “Ocular equipment manufacturers can add protective shields to the equipment. The Chinese consensus for COVID-19 eye disease will be released and the Chinese experiences shared with ophthalmologists worldwide.”

Ningli Wang, MD, PhD

E: wningli@vip.163.com

This article is adapted from Dr Wang’s presentation at the Glaucoma Research Foundation New Horizons Forum. He has no financial interest in this subject matter.

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