Dr Swagata Sarkar, Consultant Ophthalmologist and vitreoretinal surgeon, explains how COVID-19 can effect the eyes.
Novel Coronavirus, also known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is an enveloped, single-stranded RNA virus that causes COVID-19. It is highly transmissible and has a significant fatality rate, especially in the elderly and those with comorbidities such as immune suppression and diabetes mellitus. A significant number of global fatalities have occurred, and the impact is being felt worldwide leading to it being declared a Pandemic by the World Health Organisation (WHO) on March 11, 2020.
How Is SARS-CoV-2 related to your eyes?
Several recent reports suggest that SARS-CoV-2 can cause mild follicular conjunctivitis otherwise indistinguishable from other viral causes. There are also reports of SARS-CoV-2 RNA being detected in tears of COVID-19 patients with conjunctivitis. Although infectious virus has not yet been cultured from the conjunctiva of any COVID-19 patient, existing data is inconclusive whether or not it may be a source of transmission. Limiting eye exposure can, therefore, help to significantly reduce your risk of getting infected while taking care of your eyes during the COVID-19 outbreak.
How does the pandemic affect your routine eye exam visits?
To reduce the risk of becoming infected, patients are being advised to reschedule all routine in-person visits, except for urgent or emergent eye problems during the pandemic.
If you had a routine eye exam scheduled during this time most eye clinics will be in contact with you every few weeks to recommend when an in-person visit would be considered safe. In the meantime some practices have taken additional steps to continue to serve their patients using telemedicine. If you experience an eye issue that would normally require an in-person visit, you can now schedule a virtual visit on your smartphone or video chat over a computer.
If you suffer from glaucoma, how does the pandemic affect your treatment?
- Fortunately, most forms of glaucoma are chronic and slowly progressing, so, if your glaucoma was stable prior to the pandemic, as long as you are regular with your medications, delaying your visit for a few months may not have a major impact.
- Ensure that you get more than a month of essential eye drops and medicines to help you get by. Request a refill as soon as you are due and don't wait until the last minute to contact your pharmacy.
- For glaucoma not well controlled prior to the pandemic, tele-consult with your doctor to help you decide based on your specific medical history. A telephone call/video visit will allow your ophthalmologist to determine how urgently you need to be seen in the office. In addition, some eye problems and issues, such as discussion of medication changes in case of intolerance to an eye drop, help with temporary limited availability or allergy symptoms, can be resolved over a video visit.
- If you experience sudden red eye with pain, headache, nausea and vomiting, promptly call your ophthalmologist and report to the emergency room as you could be developing an attack of Acute Angle-Closure Glaucoma
Does the pandemic affect your treatment for age-related macular degeneration (AMD)?
- If you are above 60 years you should be aware that you are also at high risk due to COVID-19. So, if your dry AMD has been stable, you should most likely postpone your check-ups while continuing to monitor your vision at home using an Amsler Grid once a week.
- If you notice a sudden change in your vision it could indicate a conversion to wet AMD. Call your ophthalmologist to discuss your vision changes over the phone and determine if there is any sort of vision emergency requiring you to be seen at the clinic.
- If you have wet AMD and receive monthly injections in your eye with good sight, then you really want to prevent any further deterioration, and waiting becomes more of a concern. Call your ophthalmologist and request a phone appointment to discuss your options. Based on how long you’ve been receiving injections and how stable your vision is, it may be acceptable to postpone an injection a bit or space injections out more, to balance the risk between acquiring COVID-19 infection as against the risk of losing further vision.
Do you need to discontinue contact lens wear during the pandemic?
- Those wearing contact lenses for long hours daily along with extended periods of work on their computer screens, should be aware that they may experience dry and itchy eye symptoms significantly more often than others. This may lead to frequent rubbing of the eyes to relieve the itching exposing them to a higher risk of infection.
- While there's no evidence that wearing contact lenses increases your risk of coronavirus infection, if you wear contact lenses, consider switching to glasses for a while. Substituting glasses for lenses can decrease irritation and force you to pause before touching your eye.
- Also, consider frequent conscious blinking and adding moisturising eye drops to reduce irritation and the urge to rub your eyes.
What precautions should you take while visiting the hospital?
- Restrict the number of people with you at the time of your visit. If you do not need someone to accompany you, please do not bring them to your appointment.
- Wear a mask and maintain social distancing in the waiting room.
- Maintain hand hygiene at all times. Wash your hands with soap and water or hand sanitiser that has at least 60% alcohol in case you touch items such as doorknobs and countertops.
- Be patient and wait till you are called into the consulting room giving sufficient time for the staff to clean potential surfaces of contact with prescribed disinfectant and the doctor to practice hand hygiene before calling you into the room.
- Please wait to speak until after your eye exam is complete. Once your examination is completed and both are at the recommended safe distance from each other, then you may ask your questions.
In these unprecedented times, as the COVID-19 situation continues to evolve, with daily updates on the method of spread of the virus and the best available evidence regarding methods of preventing infection transmission, it is more important than ever that you keep up-to-date with guidance from international as well as local health authorities and adhere to all prescribed methods to keep yourself and your loved ones safe.
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Dr Swagata Sarkar
F.M.R.F (Fellow Medical Research Foundation)