Eyeworld

N EWS 44 | EYEWORLD | MAY 2020 COVID-19 NEWS YOU CAN USE competence of an individual resident/fellow as one part of the determination of whether that individual is prepared to enter the unsupervised practice of medicine," Dr. Nasca wrote. Going forward, Dr. Goshe said he has been encouraged in this tragic situation to see how the healthcare community is coming together. He also said it's important, even in the midst of the pandemic, to start taking notes of lessons learned, because "it might be better to learn it on COVID-19 than COVID-22, or whatever it might be that comes after, when all of the sud- den you have a higher mortality rate or some- thing more dangerous than what we've got." Dr. Sun has also seen an outpouring of gratitude, even amid hardship, to be in this profession. "My colleague Dr. Kyle Godfrey (an oculoplastics specialist and one of the first de- ployed to the emergency department) reflected eloquently that a crisis like this demands that we each contribute our full effort, at the top of our training, to the areas of greatest need. Our first impulse has to be to help and contribute in every way possible. Although we are young eye surgeons fortunate to have learned highly specialized microsurgical skills that allow us to prevent and cure blindness, we are physicians first, trained in the diagnosis and treatment of systemic illness. Our first priority is to care for those in need, and this crisis has made that point clearer than ever," she said. Dr. Goshe, in addition to distance learning and keeping rotations similar to how they were originally laid out, said he gave his residents the opportunity to catch up on research projects and things they could do on their own. He also said residents, in some ways, are being put in positions of greater responsibility, which is a good thing, even though the circumstances leading to increased responsibilities is not ideal. When it comes to residency timelines, Dr. Sun said all years will be affected and it is a question that will be addressed by the broader Accreditation Council for Graduate Medical Education (ACGME) community. "Given the traditional structure of resi- dency training, this will be an opportunity for reinvention," she said. When it comes to meeting surgical num- bers, Thomas Nasca, MD, ACGME president and CEO, wrote in a message to members that ACGME acknowledges residents may not be able to achieve the minimum number of visits/ cases. He also noted that these minimums were established for program accreditation. "ACGME visit/case minima were not de- signed to be a surrogate for the competence of an individual program graduate, and are not uti- lized in that manner by the Review Committees. It is up to the program director, with consider- ation of the recommendations of the program's Clinical Competence Committee, to assess the continued from page 43 Though the incidence of ocular find- ings as an initial COVID-19 indicator is low (0.8% of patients with the viral disease had ocular signs 1 ), there are some ocular manifestations to look out for. For coronaviruses in general, Francis Mah, MD, Scripps Clinic, La Jolla, California, said this group of viruses can cause a very non-specif- ic conjunctivitis. There are different ways that the conjunctivitis has been described in the literature, he added. Sometimes it is called a "con- gestion or congested conjunctiva," and most of the time a viral conjuncti- vitis is follicular. Some have described it as patients having chemosis (swelling of the conjunctiva or fluid underneath it), he said. There could also be some hyperemia. Many have asked if COVID-19 can be transmitted to someone through this conjunctivitis. According to the papers out there, Dr. Mah said, unless the patient has eye findings associated with a conjunctivitis as part of their COVID-19, the majority of patients are showing that they are not culture positive in their tears. If the patient has COVID-19 but doesn't have ocular signs and symptoms, there's most likely not going to be vi- rus in the tears. However, if the patient does have ocular symptoms, there is a chance that ocular secretions could be a viral vector, he said. The CDC, as well as AAO and ASCRS, have information and links to resources for ophthalmologists on the topic, Dr. Mah added. If you are see- ing patients, wearing a mask of any sort, gloves, and goggles/glasses is recommended. In Dr. Mah's practice, they have outfitted the slit lamps with large plastic shields to further protect physicians and patients from possible transmission. Reference 1. Guan WJ, et al. Clinical charac- teristics of coronavirus disease 2019 in China. N Engl J Med. 2020. Epub ahead of print. Contact Mah: mah.francis@scrippshealth.org Ocular manifestations of coronavirus

• Blank Page
• Blank Page (1)