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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 32  |  Issue : 2  |  Page : 107-109

Turning the crisis into an opportunity: Today's tragedy can be, tomorrow's possibility


Department of Ophthalmology, Government Medical College, Thrissur, Kerala, India

Date of Submission08-May-2020
Date of Acceptance09-May-2020
Date of Web Publication25-Aug-2020

Correspondence Address:
Dr. V Sudha
Department of Ophthalmology, Government Medical College, Thrissur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_52_20

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How to cite this article:
Sudha V. Turning the crisis into an opportunity: Today's tragedy can be, tomorrow's possibility. Kerala J Ophthalmol 2020;32:107-9

How to cite this URL:
Sudha V. Turning the crisis into an opportunity: Today's tragedy can be, tomorrow's possibility. Kerala J Ophthalmol [serial online] 2020 [cited 2020 Oct 31];32:107-9. Available from: http://www.kjophthal.com/text.asp?2020/32/2/107/293298



The COVID pandemic is a crisis of enormous proportions. In terms of human lives lost, lost livelihood issues, and resource limits, it can hardly be considered a godsend opportunity. The global spread of a disease for which there is neither a cure nor vaccination available is something that we have no experience in tackling. However, the world has to change post the pandemic. The abnormal is becoming the new normal.

Before the pandemic, there were many shortcomings to our health system. In our country, hospitals are often associated with unmanageable crowds, long queues, crowded and small workspaces, overworked staff, huge delays and waiting times, unprotected health workers due to shortage of disposable clothing, etc., The patients too used to accept these ills mainly because they were poorly informed, lack of adequate counseling, and lack of affordable alternatives.


  What Do We Need to Change? Top


Ophthalmology practice should be reorganized to reduce the risks to both the healthcare worker and the patient. Ultimately, the challenge is: How can we achieve the most good with limited resources? The new care delivery model will need to optimize clinical procedures, automate standardized workflows using supportive software to streamline operations, create the right infrastructure, improve patient access to healthcare services, and make these services more affordable and friendly for the patients.

Risk assessment should become part of routine ophthalmic practice: It becomes crucial to assess risk for visual loss to prevent unnecessary outpatient visits, especially in older patients and those with comorbidities. The strategies that can be used for risk assessment and subsequent management include virtual triaging, precision medicine, and personalized medicine.

Virtual triaging involves sorting patients for the treatment on the basis of need before they present physically to a healthcare facility, i.e. good risk stratification based on a set of clear guidelines through online questionnaires using responsive information technology solutions.

Precision medicine refers to a stratification of patients using a wide array of individual-specific data to enable precise targeting of disease subgroups, with the best available diagnostic and therapeutic approaches. Precise diagnostics and precise treatment will prevent undue testing and delays in getting appropriate care, reduce waiting time, determine significant risk factors for disease, enable early-stage diagnosis, and provide the most effective therapy to improve, preserve, and restore vision. Within ophthalmology, this strategy is being applied successfully and is most evident in the management of the inherited diseases.[1]

Personalized medicine: A high clinical need for therapeutic personalization and dosage optimization in ophthalmology may be the focus of individualized medicine in this specialty. Antivascular endothelial growth factor therapeutics in several retinal conditions, such as age-related macular degeneration (AMD), diabetic macular edema (DME), retinal vein occlusion and retinopathy of prematurity, application of recent developments in nanoemulsion and polymeric micelle for targeted delivery and drug release in glaucoma, are the models of dosage optimization, increasing efficacy, and improving outcomes in these major eye diseases.[2]

When such technologies become easily available, a subset of our patients can undergo self-care under strict guidelines. For this, it is essential that the patient undergoes seamless education so that he/she can participate in making his/her health decisions. Reassurance and communication with patients who have chronic diseases, such as dry AMD or DME, may be enhanced with home monitoring of patient symptoms. Examples include the Alleye App (Oculocare Ltd.), which enables monitoring patients on a mobile device and mobile phone-based, digitized patient-reported outcome measure – both of which permit ophthalmologists to remotely monitor patients. This was highly accurate to detect wet AMD and reasonably accurate to classify dry AMD versus wet AMD.[3]

The video eye consult technology can be developed to allow remote examination and follow-up of patients in health centers near their homes by ophthalmologists in tertiary centers. Telemedicine is a useful way to reduce face-to-face encounters at a time of mandated social distancing and self-isolation. Big Picture Medical, a cloud-based telemedicine platform linking optometrists in the community to ophthalmologists at Moorfields Eye Hospital, is such an example. It has reduced hospital attendances by more than 50% by further risk stratifying those that did need face-to-face review.[4] Video consults can also be used to discuss the optical coherence tomography or visual field reports, thereby reducing the number of contacts between clinician and patient and the time spent in clinic waiting areas.

The other need is to redesign our workspaces and improve the working conditions so that the patients who most need it should be given comfortable access to the facility without compromising on safety of either the health worker or the patient. A desirable emergency room design includes a triage area that can be closed off as an isolation area, in the event of inadvertent contamination. Isolation areas should have adjacent rooms for staff to put on and take off scrubs. Facility planning should include storage space for infection control items, good ventilation, and measures to avoid recirculation of the room air. If recirculation of the air is unavoidable, passing the air through a HEPA filter should be mandatory.

Moreover, finally, how to deliver efficient services at the clinic or hospital with minimal risks?

Digitalizing healthcare

– a digital descriptor of clinical history or scanned PDFs of referral letters and electronic medical records – may facilitate management without the risks of transmitting infection through fomites transmitted via paper records.

Leveraging artificial intelligence

– increasing accuracy, standardization and efficiency in care delivery-robotic surgery, virtual reality simulations – can transform ocular surgeries in the era of pandemics which require social distancing. This paradigm shift in provision of care is accelerated by the emergence of novel imaging technologies, robotics, and artificial intelligence, as well as emerging technologies that integrate bioinformatics data into clinically relevant knowledge.[1]

At the end, the development of technologies may lead to other unexpected yet welcome outcomes. A focus on health worker protection through specific training and encouragement of adherence to universal precautions and hygiene recommendations may become a priority. The use of technical devices by senior doctors may require the assistance of their junior counterparts. Well-established hierarchical systems may crumble, and better relationships develop between faculty and students. Group practices may become the norm as pooling of equipment, and infrastructure may become more viable in the long term.[5] Hospitals may become models of multidisciplinary care. Global and national-level cooperation may become the standard of the times. Strict adherence to guidelines formed on the basis of accurate data reporting and analysis would become routine practice. Online technologies for skill enhancement and education of postgraduates, general ophthalmologists, and the public would hopefully be freely available. Innovations would rule the day.

As the saying goes – “there is always a silver lining in every cloud….”



 
  References Top

1.
Roizenblatt M, Roizenblatt J, Jiramongkolchai K, Gehlbach PL, Brant P, Maia M, et al. Precision medicine in ophthalmology: an evolving revolution in diagnostic and therapeutic tools. In: Faintuch J, Faintuch S, editors. Precision Medicine for Investigators, Practitioners and Providers. Ch. 35. USA: Academic Press; 2020. p. 361-8.  Back to cited text no. 1
    
2.
Ong F, Kuo J, Wu WC, Cheng, CY, Blackwell W, Taylor B, et al. Personalized medicine in ophthalmology: From pharmacogenetic biomarkers to therapeutic and dosage optimization. J Personalized Med 2013;3:40-69.  Back to cited text no. 2
    
3.
Schmid MK, Thiel MA, Lienhard K, Schlingemann RO, Faes L, Bachmann LM. Reliability and diagnostic performance of a novel mobile app for hyperacuity self-monitoring in patients with age-related macular degeneration. Eye (Lond) 2019;33:1584-9.  Back to cited text no. 3
    
4.
Kern C, Fu DJ, Kortuem K, Huemer J, Barker D, Davis A, et al. Implementation of a cloud-based referral platform in ophthalmology: Making telemedicine services a reality in eye care. Br J Ophthalmol 2020;104:312-7.  Back to cited text no. 4
    
5.
Sachdev MS, Tamilarasan S. Survival tool kit for ophthalmic practices during difficult times: Build your resilience in the face of crisis. Indian J Ophthalmol 2020;68:679-82.  Back to cited text no. 5
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