Safety Recommendations and Medical Liability in Ocular Surgery during the COVID-19 Pandemic: An Unsolved Dilemma

Abstract

Ocular surgery is one of the most performed medical procedures in the world. Its limitation or suspension, recursively extended over time, could be associated with a significant increase in the number of blind people worldwide. Indeed, cataract causes more than half of all cases of visual impairment in those countries with limited availability of means for performing eye operations (e.g., Africa or India). In this scenario, the pandemic of coronavirus disease 2019 (COVID-19) quickly resulted in the suspension or sharp reduction of various ophthalmic activities considered non-urgent, including lens replacement surgery or some intraocular injections. Despite the imperative need to continuously practice eye operations to avoid the abovementioned problems, there are currently little-shared and vague recommendations among the various countries on safety in operating rooms (for health care workers and patients) and poor legal protection for surgeons (potentially transmitting the COVID-19 infectious agent). Herein, we individuated and discussed some critical points in safety recommendations and medical liability. A paradigm shift for ocular surgery during the COVID-19 era is now mandatory. While telemedicine has been able to solve some problems in clinical ophthalmology, the lack of adequate health and legal protection for surgeons and patients may result in an excessive reduction in the volume of surgical interventions during a pandemic era and the immediately following period, thus determining inability to ensure health care to all patients.

<p>The Role of the Ocular Tissue in SARS-CoV-2 Transmission</p>

“…Napoli et al summarized potential risks and potential solutions to minimize viral exposure for eye surgeons. 52 The authors emphasized the possibility of generating bioaerosols during lacrimal procedures. More research is needed to determine these risk factors and find out effective strategies to protect practitioners.…”

<p>COVID-19 Lockdown and Eye Injury: A Case Series from Jordan</p>

“…The reopening was based on the disease epidemiological situation in each local area and on implementing guidelines and strict protective measures to protect patients and health-care workers during the pandemic. 14 In the year preceding the COVID-19 lockdown, the ophthalmology department at KAUH dealt with 11 cases of ruptured globe, three of which resulted from trauma inside houses, and only one of which was in a form of wound dehiscence of a PK. Although the difference between the rate of ruptured globe cases during the strict lockdown period and the year preceding it was not clinically significant (p=0.3), we believe this could have resulted from the small number of cases overall.…”

“…These guidelines were based on recommendations from the American Academy of Ophthalmology (AAO), 9 International Council of Ophthalmology (ICO), 10 and on different published papers that discussed protocols and effective measures to prevent COVID-19 transmission. [11][12][13][14] These recommendations included the use of protective goggles, face shields, slit lamp breath shields, disposable gloves, thorough hand washing with soap and water, and disinfection of examination rooms and slit lamps after each examination. In addition, general protective measures were strictly implemented inside the hospital such as the use of a face mask, social distancing, and body temperature measurement for every single patient.…”

Coronavirus disease 2019 (COVID 19) and Malaria

“…In addition according to the data of WHO the dashboard of the pandemic in the most African countries is very low and in some nations the total cases of COVID-19 are less than 10 units [5] and nowadays experts still do not know how so few cases of the new virus had been reported despite China, where the virus originated, being the continent's top trading partner. It can be due to a lack of detection or the monitoring efforts are weak [6]. In the African continent malaria is one of the diseases which cause significant morbidity and mortality.…”