The COVID-19 pandemic has seen a surge in the number of submitted papers across journals of any medicine branch, and Ophthalmology was not an exception. Although few reported direct involvements of ocular structures with the coronavirus (SARS CoV-2), it has impacted the ophthalmology practice in ways more than one. The authors reviewed all PubMed-indexed articles published from 1st March 2020 to 8th August 2020 in the English language. The search was carried out using various combinations of the following terms:“ophthalmology,”“ophthalmic,” “ eye,” “COVID-19,” “pandemic,” and “SARS-CoV-2.” Cross-references from obtained articles were reviewed. The articles were then listed by the type of article (reviews, original articles, case reports, short communications, perspectives, editorials). They were categorized as those reporting the ophthalmic involvement in COVID-19, guidelines for ophthalmic practice, teleophthalmology, and impact on ophthalmic practice. A total of 434 articles have been published on COVID-19 and Ophthalmology. Table 1 provides an overview of the categories of these 434 published papers (supplementary file contains the journal wise publications).
2.1 Ophthalmic involvement with COVID-19
Older age, high fever, increased neutrophil/lymphocyte ratio, and high levels of acute-phase reactants were quoted as risk factors for ocular involvement. The direct ophthalmic involvement with the virus occurs as follicular conjunctivitis (6.3% prevalence) that occurs late in the disease course and is usually self-limiting. The frequent hand-eye contact correlated with the conjunctival congestion observed in the cohort of 535 cases of COVID-19 in Wuhan, China.
2.2 Tele ophthalmology
Tele ophthalmology practice was adapted well by the ophthalmic community in this pandemic. Many ophthalmology branches reported its successful use in triaging the patient (if hospital visit required) and managing the follow-up patients. Even rehabilitation services could be provided with the help from families and therapists using telemedicine. The reported concerns were the medicolegal issues like consents, right to refusal (for both the patient and the doctor), monetization, and its implications and scope of jurisdiction.
2.3 Impact on ophthalmic practice and guidelines
The guidelines for the resumption of services are laid for almost every ophthalmology subspecialty by several societies. Since the current evidence suggests only a low-risk of transmission through conjunctival surfaces and tears, personal protective gear and precautions in outpatients and operating rooms have been deemed sufficient for slowly returning to the new normal across the ophthalmic subspecialties. There is no valid scientific study establishing the viral tropism for ocular structures. The use of irradiated corneas, glycerol preserved corneas for transplant, use of ultraviolet rays and hydrogen peroxide vapor for decontamination of respirators, and smartphone assisted slit-lamp examination are some of the novel and innovative applications brought into ophthalmic practice by this pandemic. Ophthalmology trainees' surgical training has significantly suffered; however, there were several academic activities, including conferences and workshops facilitated by electronic media.
The recent publications have catered to the need of ophthalmologists in managing their practice amidst the COVID-19 pandemic. The publications also brought to the fore the global ophthalmic community's ingenuity and its ability to stand up to mammoth challenges of the new era.
2.4 Financial support and sponsorship
2.5 Conflicts of interest
There are no conflicts of interest.
Supplementary File: Contains the detailed journal wise distribution of published articles
Chen L, Deng C, Chen X, Zhang X, Chen B, Yu H, et al Ocular manifestations and clinical characteristics of 535 cases of COVID-19 in Wuhan, China: A cross-sectional study Acta Ophthalmol. 2020 doi:101111/aos14472
Das AV, Rani PK, Vaddavalli PK. Tele-consultations and electronic medical records driven remote patient care: Responding to the COVID-19 lockdown in India Indian J Ophthalmol. 2020;68:1007–12
Christy B, Keeffe J. Telerehabilitation during COVID-19: Experiences in service delivery from South India Indian J Ophthalmol. 2020;68:1489–90
Jayadev C, Mahendradas P, Vinekar A, Kemmanu V, Gupta R, Pradhan ZS, et al Tele-consultations in the wake of COVID-19 - Suggested guidelines for clinical ophthalmology Indian J Ophthalmol. 2020;68:1316–27
Sengupta S, Honavar SG, Sachdev MS, Sharma N, Kumar A, Ram J, et al All India Ophthalmological Society - Indian Journal of Ophthalmology consensus statement on preferred practices during the COVID-19 pandemic Indian J Ophthalmol. 2020;68:711–24
Sharma N, D'Souza S, Nathawat R, Sinha R, Gokhale NS, Fogla R, et al All India Ophthalmological Society-Eye Bank Association of India consensus statement on guidelines for cornea and eyebanking during COVID-19 era Indian J Ophthalmol. 2020;68:1258–62
Gupta N, Dhasmana R, Maitreya A, Badahur H. Glycerol-preserved corneal tissue in emergency corneal transplantation: An alternative for fresh corneal tissue in COVID-19 crisis Indian J Ophthalmol. 2020;68:1412–6
Mishra D, Nair AG, Gandhi RA, Gogate PJ, Mathur S, Bhushan P, et al The impact of COVID-19 related lockdown on ophthalmology training programs in India - Outcomes of a survey Indian J Ophthalmol. 2020;68:999–1004