Eyeworld

84 | EYEWORLD | APRIL 2020 by Clara Chan, MD Cornea Editor T his is a turbulent time in the world with the pandemic COVID-19 sweep- ing through North America. In To- ronto and most of Canada, in regard to cornea specifically, all our elective corneal transplants have been canceled. The eye bank also closed for a period of time and now operates with a skeleton crew with most staff working from home in order to ensure safe social distanc- ing for those who are physically in the office. Deceased ocular tissue is being recovered and processed only for emergency surgeries, such as corneal perforations not amenable to glue and glaucoma tube shunts for patients with uncon- trolled intraocular pressures. The reason for this is multifactorial: to save personal protective equipment (PPE for frontline staff interfacing with COVID-19 patients who need it most), to reduce risk to the recovery and processing technicians, to encourage social distancing, and because there is no validated means at this time to test deceased donors for COVID-19 and since donors can be carriers while asymptomat- ic, it makes it very hard to screen donors. Also, we need to conserve COVID-19 test kits for those in need. The status of how we will proceed is uncer- tain even once elective corneal transplants can be booked again. Currently, if we are to release a corneal tissue for emergency use, it is released under "exceptional distribution," which means the surgeon has to tell the patient there is a risk of COVID-19 transmission, and the patient has to consent to accept that risk. This process is no different than when patients receive a blood transfusion; they have to consent to accept the potential risks associated with transfusion. There are also the financial and social ram- ifications, which do not affect just the cornea subspecialty alone. In-person non-emergency office visits are canceled. Almost all diagnostics are canceled (OCTs, visual fields, topography, etc.). Staff (technicians, admins, etc.) are being temporarily laid off due to lack of work in some offices. Doctors can bill a telemedicine visit code but need to accept an increased medi- cal-legal risk since no slit lamp exam is possible. Offices have had to purchase protective equip- ment (masks, slit lamp shields, gloves, goggles) and institute screening procedures if patients do come for appointments. Doctors who have children have to cut back hours in order to ensure someone is at home to homeschool and watch their children since schools are closed. Psychologically, the situation has also affected physicians who are worried about their increased risk due to being on the frontlines interfacing with many patients. The virus can be spread among asymptomatic people, and previously healthy, young doctors have died. Ophthalmologists and ENT specialists were at higher risk in China for contracting the virus. I have friends and colleagues talking about needing to get their wills and estate affairs in order "just in case." Given that COVID-19 is spreading among the community, some of these changes instituted in the office may need to be continued long term. Although times are uncertain, everyone is trying their best to adapt as more information is known, and we will per- severe. Hopefully we can return to some degree of normalcy soon. C ORNEA Cornea Editor speaks on unprecedented times

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